Horizon BCBSNJ Credentialing Update 2025

Horizon BCBSNJ Updates Credentialing Policy for Hospital Admitting Privileges – Effective May 1, 2025 

Effective May 1, 2025, Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) will implement important updates to its Credentialing and Recredentialing Administrative Policy regarding hospital admitting privileges. These changes are part of Horizon’s broader effort to reduce administrative complexity for healthcare providers while preserving quality and continuity of care for its members. 

Key Policy Changes 

The updated policy, applicable to all physicians and healthcare professionals participating in Horizon Managed Care, Horizon PPO, and Horizon NJ Health networks, includes the following changes: 

• Elimination of admitting privilege requirements for certain physician specialties. 
• Clarification of timelines and obligations for providers whose specialties still require admitting privileges. 

These revisions are detailed in the Network Hospital section under Standards for Participation and affect both credentialing and recredentialing processes. 

Specialties No Longer Required to Maintain Admitting Privileges 

Starting May 1, 2025, the following provider specialties will no longer be required to maintain hospital admitting privileges at an in-network facility: 

• Family Medicine Physicians 
• General Internists providing primary care 
• Pediatricians 

This change applies to both existing participants and newly joining providers in these specialties. Horizon’s update reflects the growing use of hospitalist models and the fact that many primary care providers deliver services exclusively in outpatient settings. 

Requirements When Admitting Privileges Are Still Necessary 

For specialties where admitting privileges remain a requirement, Horizon has clarified expectations in cases where a participating hospital ends its contract with the insurer: 

• Providers must obtain admitting privileges at another in-network hospital before the termination date of the current hospital’s contract. 
• Providers who fail to secure alternative privileges will face termination from Horizon’s networks. 

As an alternative, affected physicians may choose to sign Horizon’s Continuity of Care Coverage Agreement, which allows them to meet participation standards without securing new admitting privileges. 

Aimed at Reducing Administrative Burden 

These policy updates are designed to support providers by: 

• Reducing unnecessary credentialing steps for non-hospital-based physicians 
• Ensuring smoother transitions when hospital relationships change 
• Maintaining high clinical standards while aligning credentialing practices with evolving care delivery models 

Provider Action Required 

Horizon BCBSNJ encourages all participating providers to review the updated credentialing policy carefully and ensure any necessary steps are taken before the effective date of May 1, 2025. 

For questions or to access the updated standards, providers should visit Horizon’s official provider portal or contact their network representative. 

 

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