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Horizon NJ Health Site Map Contact Us Directions Important Phone Numbers Members Physician Directories Our Programs Mom's GEMS CHAMPS Asthma 'Breathe Easy' Program Diabetes Management Program Take Five if You have Diabetes! Diabetes Guidelines Congestive Heart Failure Social Case Management Signing Up and Getting Started in Horizon NJ Health Blue Notes 2007 Issues 2006 Issues 2005 Issues 2004 Issues 2003 Issues 2002 Issues 2001 Issues Commonly Asked Questions When to Use the Emergency Room NJ FamilyCare What Is NJ FamilyCare? Who Is Eligible? How Do I Apply? NJ FamilyCare Online Application How Much Does It Cost? What Is Covered? Complete Coverage Backed By A Name You Trust A Personal Horizon NJ Health Doctor and Dentist Renew Your NJ FamilyCare Eligibility! NJ FamilyCare Expands Coverage to Certain Parents NJ FamilyCare Advantage Who Is Eligible? How Do I Apply? How Much Does It Cost? EPSDT Member Services Contact Us Directions Important Phone Numbers News Archives Physicians Physician Login Providers Physician Directory Physician and Health Care Center Check Claim Status Confirm Member Eligibility Physician Newsletters Formulary and Alternatives Smoking Cessation Claims Filing Date of Service Horizon NJ Health Will Extend Coverage to the Intranasal Flu Vaccine Claims Addresses Forms and Guides Physicians and Health Care Professionals Reference Materials Physician and Health Care Professional Manual Clinical and Preventive Guidelines and Policies Medical Policies Claims Processing and Payment Requirements for Filing Claims General Requirements Procedures for Claim Submission Claim Filing Deadlines Claim Forms (Paper) CMS 1500 (HCFA 1500) Claim Form (Paper Submissions) The UB-92 (CMS 1450) Claim Form (Paper) Procedures for Electronic Submission - Electronic Data Interchange Hardware/Software Requirements Specific Data Record Requirements Electronic Claim Flow Description Invalid Electronic Claim Record Electronic Billing Inquiries Common Coding Requirements Diagnosis Codes Procedure Codes Modifiers Units Other Coding Common Billing Modifiers Requirements Common Causes of Claim Processing Delays, Rejections or Denials Authorization or Referral Number Invalid or Missing Billed Charges Missing or Incomplete Claim Information Does Not Match Authorization Coordination of Benefits (COB) Information Missing or Incomplete Diagnosis Code Missing 4th or 5th Digit Diagnosis, Procedure or Modifier Codes Invalid or Missing DRG Codes Missing or Invalid Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Information Missing or Incomplete Eligibility/Enrollment Explanation of Benefits (EOB) Missing or Incomplete Illegible Claim Information Incomplete Forms Newborn Claim Information Missing or Invalid Payer or Other Insurer Information Missing or Incomplete Place of Service Code Missing or Invalid Procedure/Service Code Does Not Match Authorization Physician Name Missing or Invalid Hospital, Physician or Health Care Professional Identification Number Missing or Invalid Revenue Codes Missing or Invalid Spanning Dates of Service Do Not Match the Listed Days/Units Signature Missing Employer Identification Number (EIN) Missing or Invalid Third Party Liability (TPL) Information Missing or Incomplete Type of Service Code Missing or Invalid Unbundled Services Invalid Attachments Missing From Original Claim Coordination of Benefits Medicare Other Third Party Medical Insurance Reimbursement Services Which Do Not Require A Primary Insurer EOB Denials from Primary Insurers Processing Rules Encounter Data Submissions Remittance Advice Documentation National Provider Identifier (NPI) What NPI Is and How It Works NPI Glossary Downloadable Forms and Articles FAQs About NPI NPI Timeline Contact Us Directions Important Phone Numbers News Archives In The News Press Releases 2008 March 11, 2008 February 1, 2008 2007 August 5, 2007 June 12, 2007 May 17, 2007 May 9, 2007 April 17, 2007 March 6, 2007 January 18, 2007 2006 August 07, 2006 June 06, 2006 May 31, 2006 April 18, 2006 January 24, 2006 January 23, 2006 2005 October 18, 2005 September 30, 2005 June 10, 2005 June 10, 2005 May 16, 2005 February 11, 2005 February 10, 2005 2004 May 25, 2004 2003 June 10, 2003 April 14, 2003 March 18, 2003 February 24, 2003 2002 July 16, 2002 April 22, 2002 March 28, 2002 March 6, 2002 March 5, 2002 February 28, 2002 February 21, 2002 January 15, 2002 Karen L. Clark Wal-Mart Joins the Pharmacy Network Horizon/Mercy Is Now Horizon NJ Health! Skin Cancer Awareness Don't Let the Flu Catch You Colorectal Cancer Screening Selecting and Changing Your Primary Care Physician (PCP) and Dentist A Reminder for Men Physician Spotlight Dr. Sharon Buttress and CAMcare Jersey Shore University Medical Center Marc Roberts, M.D. Jersey City Family Health Center Children's Hospital of New Jersey (CHNJ) Social Case Management at the Bedside Outreach Program Curbing Adult Obesity Join a Horizon NJ Health Committee Making the Connection: The Health of Black Women Care After a Heart Attack Careful Antibiotic Use Prevent Tooth Decay from Baby Bottles and Sippy Cups About Horizon NJ Health Company Overview Mission, Vision, and Cornerstones Company History Contact Us Directions Important Phone Numbers Community Health Links Employment Site Map Legal Notice Privacy Policy