Horizon NJ Health requires that all non-traditional providers use the standard CMS 1500 claim form to report services which are reimbursable. The CMS 1500 form is the standard claim form used by a non-institutional provider or supplier to bill Medicaid Managed Care Plans.

We recently issued a provider letter noting that Horizon NJ Health has streamlined the process for ordering in-home studies for obstructive sleep apnea (OSA). We now require no referrals and no pre-authorizations for in-home testing. Since then, a few questions have surfaced, so we’d like to address them.

The superior convenience and comfort of in-home studies for obstructive sleep apnea (OSA) increases patients’ willingness to comply with your orders for this testing. To facilitate the process for both our providers and our members who are your patients, Horizon NJ Health has simplified the ordering process for in-home OSA studies. We are also selecting proven and reliable suppliers for home-based sleep studies.

Effective July 1, 2014, members receiving Managed Long Term Services and Supports (MLTSS) benefits will be mandated into Medicaid managed care from the Medicaid fee-for-service environment. This includes members in the following home- and community-based services (HCBS) waiver programs: