Horizon Credentialing Policy Update: Hospital Admitting Privileges Changes

Horizon Updates Credentialing Policy: Changes to Hospital Admitting Privileges 

Effective Date: May 1, 2025 

Horizon has announced updates to its Credentialing and Recredentialing Policy for Participating Physicians and Healthcare Professionals, introducing significant changes regarding hospital admitting privileges. These updates aim to streamline administrative requirements while maintaining high standards of patient care. 

Key Changes in the Policy 

The revised policy includes two primary updates: 

1. Certain specialties will no longer require admitting privileges at in-network hospitals. 
2. Updated requirements for obtaining admitting privileges when necessary. 

These modifications are reflected in the Network Hospital section under Standards for Participation and will affect both current and newly joining network physicians. 

Specialties No Longer Requiring Admitting Privileges 

As of May 1, 2025, physicians in the following specialties are no longer required to maintain admitting privileges at an in-network hospital: 

• Family Physicians 
• General Internists providing primary care 
• Pediatricians 

This change reduces administrative burdens for providers who do not deliver hospital-based care while ensuring continued access to quality healthcare for Horizon members. 

Admitting Privileges Requirement When Necessary 

For specialties where admitting privileges are still required, the policy outlines new guidelines in cases of hospital termination: 

• Physicians must obtain admitting privileges at a participating hospital before the termination’s effective date. 
• Failure to secure new admitting privileges will result in removal from Horizon’s provider networks. 
• As an alternative, physicians may complete Horizon’s Continuity of Care Coverage Agreement instead of obtaining new hospital admitting privileges. 

Compliance with the New Policy 

These changes apply to all providers participating in the following networks: 

• Horizon Managed Care 
• Horizon PPO 
• Horizon NJ Health Networks 

By refining its credentialing policy, Horizon aims to protect patients, reduce administrative complexities for physicians, and ensure network stability. Providers are encouraged to review these updates to ensure compliance and avoid potential disruptions. 

For additional details, providers should consult Horizon’s updated administrative policies or contact Horizon’s provider support team. 

Source: Horizon 

 

 

 

Read more articles