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Horizon-ASH Conference Call Recording & Information
If you missed the Statewide Conference Call regarding the Horizon-ASH agreement you can listen to the recording here.
You may have or will soon be receiving a letter from Horizon announcing that they have entered into an agreement with American Specialty Health Networks (ASH). ASH will be providing network management services for Horizon beginning January 1, 2020.
ASH will be responsible for all aspects of provider network management for all physical medicine services including acupuncture, chiropractic, occupational therapy, physical therapy and speech therapy.
Horizon advises that this ASH management will be applied to fully and self-funded plans including Advantage EPO, Direct Access, EPO, Federal Employee Program, HMO, Indemnity, Medicare Advantage, OMNIA Health plans, PPO, POS, SHBP/SEHBP plans and all self-insured Administrative Services Only (ASO) employer groups. The only exclusions to the ASH management will be the Horizon NJ Health plans (Medicaid), Medicare Supplemental (Medigap plans) and Horizon NJ TotalCare (HMO SNP).
If you are not already contracted with ASH you must become a member of the ASH network no later than October 18, 2019. Additionally, you will need to sign a “Subordination Agreement Amendment” provided by ASH. This will allow the ASH contract to supersede your Horizon contract while this agreement is in place. This must be completed by November 1, 2019 in order to remain in network. If Horizon terminates its agreement with ASH then your Horizon contract will revert back to its prior status.
If you are in-network with Horizon and choose not to sign the subordination agreement then the letter Horizon is sending out will serve as their written notice of termination of your contract with them. Your contract will terminate effective Jan. 1, 2020. Horizon notes that your participating provider agreement includes a four month contract extension period where you would still be bound by the terms of the contract for four months beyond the contract termination. In this case, this period would run through April 30, 2020.
For in-network providers, the ASH fee schedule will apply in place of the Horizon fee schedule as of Jan. 1, 2020. In order to review the contract and fee schedule prior to deciding how to proceed, Horizon advises that providers who are in-network with Horizon but not in-network with ASH will be sent the provider services agreement and fee schedule to review. In-network providers will be subject to medical necessity review after a “certain number of visits” “ASH’s Client Summaries define when clinical information should be submitted.” We are seeking additional information on this but it seems the exact number may vary by plan or employer group.
Out-of-Network providers will be subject to medical necessity review after the 5th visit. Out-of-network provider claims will be processed in accordance with the members’ benefit/eligibility and Horizon BCBSNJ’s out-of-network fee schedule. Out of network claims will have to be submitted to ASH.
We will update with additional information as received.