New Jersey officials reject Horizon BCBS' new claims review policy

The New Jersey Department of Banking and Insurance rejected a proposal from Horizon Blue Cross Blue Shield of New Jersey that would have outsourced some claim reviewal and medical necessity determination to a third-party company, according to the North Jersey Record.

Beginning Jan. 1, Horizon planned to contract with American Specialty Health Network to oversee coverage of its chiropractic, physical therapy, occupational therapy and acupuncture claims. New Jersey chiropractors and others fiercely objected the plan, arguing it would increase improper denial rates. In September, Horizon sued a physician advocacy group after the group urged patients to fight the policy change.

New Jersey's insurance Commissioner Marlene Caride ultimately rejected the proposal Oct. 11. Horizon and American Specialty Health are able to resubmit a new contract, however Horizon said Oct. 17 it would stop pursuing the proposal for now.

American Specialty Health has been involved in recent legal disputes. In September, the third-party claims processor and Cigna agreed to a $20 million settlement to resolve two lawsuits concerning payment for chiropractic care.

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