What is Horizon BCBSNJ's Regional Programs of Quality initiative?
Horizon BCBSNJ’s Regional Programs of Quality (RPQ) initiative compiles information from well-recognized, independent quality sources and then summarizes this information into an easy-to-understand format. This information is based on specific criteria established by external, independent review agencies that are reported in publicly available data. Horizon BCBSNJ’s RPQ provides this independent quality information in order to help our members and physicians make health care decisions. RPQ encourages referring physicians to select specialists who are affiliated with these facilities.  Back to Top
What services are included?
At this time, Horizon BCBSNJ acknowledges specially recognized facilities for the following procedures and services: Back to Top
Do all Horizon BCBSNJ members need to have related procedures performed at a Regional Program of Quality?
No. This list is for informational purposes only. Using an RPQ does not impact member benefits. Back to Top
My local hospital isn't on this list. Why not?
We are proud that our network hospitals are all high-quality facilities, and some have been recognized based on performance measures. With 69 hospitals in New Jersey and seven hospitals in Pennsylvania and Delaware, the Horizon Hospital Network offers many high-quality facilities from which our members and participating physicians may choose. Back to Top
What if a physician doesn't have admitting rights to an RPQ hospital?
As always, Horizon BCBSNJ encourages physicians to discuss what facility best meets their patients’ health care needs. Back to Top
What criteria were used to select Regional Programs of Quality?
Various independent sources were used to determine Regional Programs of Quality: - The Regional Programs of Quality for invasive cardiology procedures were determined using evidence-based criteria derived from MedPar data and national guidelines.
- Each of the Regional Programs of Quality for specialty pediatric services in New Jersey has been designated as a Children’s Hospital by the New Jersey Department of Health and Senior Services. In addition, the Children’s Hospital of Philadelphia (CHOP), a participating hospital with Horizon BCBSNJ, has been consistently recognized by national sources as the top pediatric hospital in the country.
- When recognizing Regional Programs of Quality for oncology, Horizon BCBSNJ referenced those facilities designated as either Comprehensive or Clinical Cancer Centers by the National Cancer Institute.
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Are claim payments and reimbursement affected by this initiative?
No. Back to Top
Are physicians required to refer patients to an RPQ facility?
No. This list is for informational purposes only. However, we do encourage members to consider this information and discuss these options with their physician when deciding where to have certain procedures performed. Back to Top
How can a facility become a Horizon BCBSNJ Regional Program of Quality?
Facilities can contact their Horizon BCBSNJ Hospital Account Executive for further information. Back to Top
My local hospital isn't on the list. Why not?
We are proud that our network hospitals are all high-quality facilities,and some have been recognized based on performance measures. Your facilitymay not meet the minimum volume criteria for recognition or all of thephysicians related to the facility may not participate with HorizonBCBSNJ. With 69 hospitals in New Jersey and seven hospitals in Pennsylvania and Delaware, the Horizon Hospital Network offers many high-qualityfacilities from which our members and participating physicians may choose. Back to Top
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