Horizon BCBS New Jersey

Overview

New Jersey Blue Cross Blue Shield plan. Supports delegated credentialing arrangements.

Delegation requires provider-facing credentialing emails. A unique Horizon NJ requirement for delegated credentialing: the provider must receive a credentialing-approval email. This blocks Medallion’s global “turn off credentialing emails” setting for any customer with an active Horizon NJ delegation. Open question: whether the email can be customized/white-labeled per customer brand (e.g. so the provider sees the group’s name, not “Confluent Health”).
Commercial vs. Horizon NJ Health (Managed Medicaid) approval timing. Horizon NJ issues commercial and managed Medicaid approvals on separate timelines; managed Medicaid approval depends on Medicaid approval coming first. Medallion currently shows both under a single “Horizon Blue Cross Blue Shield” line, so care centers cannot distinguish which line of business is approved. Workaround: once commercial approval arrives, edit the enrollment and add the commercial line of business (split effective dates if different). Raised by Advocare 2026-04-20; per Gong 2026-04-20.

Delegation quirk: provider credentialing emails are mandatory — not optional — under Horizon NJ’s delegation requirements. Flag this before flipping customer-wide email settings.

Confluent — global email-off request pending; Horizon NJ delegation at another client (unnamed) is the constraint that came up in 4/15 sync.
Advocare — raised commercial vs. managed Medicaid line-separation issue 2026-04-20.