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- Submitting Pharmacy Claims for COVID-19 VaccinationsSubmitting Pharmacy Claims for COVID-19 Vaccinations
- Antibody testing: FDA and CDC do not recommend use to determine immunityAntibody testing: FDA and CDC do not recommend use to determine immunity
- June 2021 Updates: COVID-19 treatment cost share waiverJune 2021 Updates: COVID-19 treatment cost share waiver
- Reminder: Use correct codes when evaluating for COVID-19Reminder: Use correct codes when evaluating for COVID-19
- Policy Update: Antibody Testing ClaimsPolicy Update: Antibody Testing Claims
- Update: Members’ cost sharing waived for treatment of COVID-19 through June 2021Update: Members’ cost sharing waived for treatment of COVID-19 through June 2021
- Submitting claims for COVID-19 vaccines delivered in non-traditional medical settingsSubmitting claims for COVID-19 vaccines delivered in non-traditional medical settings
- For Essential Workers, COVID-19 Treatment Covered Under Workers' Compensation BenefitsFor Essential Workers, COVID-19 Treatment Covered Under Workers' Compensation Benefits
- COVID-19 Vaccine COVID-19 Vaccine
- COVID-19 vaccines will be covered at 100%COVID-19 vaccines will be covered at 100%
- Coverage for antibody infusion therapyCoverage for antibody infusion therapy
- Update: Cost-share waiver for telemedicine and COVID-19 testing extendedUpdate: Cost-share waiver for telemedicine and COVID-19 testing extended
- Reminder: Horizon NJ Health members are not responsible for PPE chargesReminder: Horizon NJ Health members are not responsible for PPE charges
- Behavioral Health Continuity During the COVID-19Behavioral Health Continuity During the COVID-19
- COVID-19 Frequently Asked QuestionsCOVID-19 Frequently Asked Questions
- Reminder to use specific codes when evaluating for COVID-19Reminder to use specific codes when evaluating for COVID-19
- Referrals no longer required for in-network specialistsReferrals no longer required for in-network specialists
- Providing telephonic care with no costs to membersProviding telephonic care with no costs to members
- COVID-19 Response: Eliminating Cost-Sharing for Qualified In-Network Telemedicine ServicesCOVID-19 Response: Eliminating Cost-Sharing for Qualified In-Network Telemedicine Services
- Telemedicine and Telehealth Services Reimbursement PolicyTelemedicine and Telehealth Services Reimbursement Policy
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ResourcesResources
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- 21st Century Cures Act21st Century Cures Act
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Credentialing and Recredentialing ResponsibilitiesCredentialing and Recredentialing Responsibilities
- Credentialing and Recredentialing Responsibilities
- Credentialing and Recredentialing Policy for Participating Physicians and Healthcare ProfessionalsCredentialing and Recredentialing Policy for Participating Physicians and Healthcare Professionals
- Credentialing and Recredentialing Policy for Ancillary and Managed Long Term Support Service (MLTSS) ProvidersCredentialing and Recredentialing Policy for Ancillary and Managed Long Term Support Service (MLTSS) Providers
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Federally Qualified Health Center (FQHC)Federally Qualified Health Center (FQHC)
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- Federally Qualified Health Center (FQHC) Resource GuideFederally Qualified Health Center (FQHC) Resource Guide
- Federally Qualified Health Center (FQHC) - Dental Billing GuideFederally Qualified Health Center (FQHC) - Dental Billing Guide
- DAVIS VISION Federally Qualified Health Center (FQHC) – Vision Billing GuideDAVIS VISION Federally Qualified Health Center (FQHC) – Vision Billing Guide
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FormsForms
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- Age - Appropriate EPSDT FormsAge - Appropriate EPSDT Forms
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Laboratory Corporation of America (LabCorp)Laboratory Corporation of America (LabCorp)
- Laboratory Corporation of America (LabCorp)
- LabCorp Alert and Panic Results PolicyLabCorp Alert and Panic Results Policy
- LabCorp Connectivity SolutionsLabCorp Connectivity Solutions
- LabCorp introduces RoadNet®LabCorp introduces RoadNet®
- LabCorp Beacon<sup>TM</sup>: PatientLabCorp Beacon<sup>TM</sup>: Patient
- NuSwab: Candida and STD testingNuSwab: Candida and STD testing
- Medicaid Reimbursement and BillingMedicaid Reimbursement and Billing
- MLTSS Bed Type Revenue CodesMLTSS Bed Type Revenue Codes
- MLTSS Non-Medical Professional Provider ManualMLTSS Non-Medical Professional Provider Manual
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- MUE Rule Notification Letter MedicaidMUE Rule Notification Letter Medicaid
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PoliciesPolicies
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Reimbursement Policies & GuidelinesReimbursement Policies & Guidelines
- Reimbursement Policies & Guidelines
- Add-on Payment for COVID-19 Diagnostic Testing Run on High Throughput Technology (U0005)Add-on Payment for COVID-19 Diagnostic Testing Run on High Throughput Technology (U0005)
- Advance Care PlanningAdvance Care Planning
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- Anesthesia Reimbursement GuidelinesAnesthesia Reimbursement Guidelines
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- Brachytherapy Billing RequirementsBrachytherapy Billing Requirements
- Breastfeeding ReimbursementBreastfeeding Reimbursement
- Care Management Services for Substance Use DisordersCare Management Services for Substance Use Disorders
- Centering Pregnancy Prenatal CareCentering Pregnancy Prenatal Care
- Chiropractic Manipulation Diagnosis PolicyChiropractic Manipulation Diagnosis Policy
- Chronic Care ManagementChronic Care Management
- Claim Editing PolicyClaim Editing Policy
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- COVID 19 Antibody TestingCOVID 19 Antibody Testing
- Daily Maximum Units for Surgical Pathology and Microscopic ExaminationDaily Maximum Units for Surgical Pathology and Microscopic Examination
- Diabetic Screening ServicesDiabetic Screening Services
- DIR ServicesDIR Services
- Distinct Procedural Service Modifiers (59, XE, XP, XS, XU)Distinct Procedural Service Modifiers (59, XE, XP, XS, XU)
- Doula ServicesDoula Services
- Early Elective DeliveriesEarly Elective Deliveries
- Multiple Diagnostic Cardiovascular ProceduresMultiple Diagnostic Cardiovascular Procedures
- Endoscopic Retrograde Cholangiopancreatography (ERCP)Endoscopic Retrograde Cholangiopancreatography (ERCP)
- Evaluation and Management Services billed with Global Radiology, Stress Test, Stress Echo or Myocardial Profusion ImagingEvaluation and Management Services billed with Global Radiology, Stress Test, Stress Echo or Myocardial Profusion Imaging
- False ClaimsFalse Claims
- Foot Orthotic Shoes and InsertsFoot Orthotic Shoes and Inserts
- Free Flap Breast ReconstructionFree Flap Breast Reconstruction
- Frequency of Ocular PhotographyFrequency of Ocular Photography
- Home Health Certification and Re-CertificationHome Health Certification and Re-Certification
- Laboratory Services Billed by PhysiciansLaboratory Services Billed by Physicians
- Maternity ReimbursementMaternity Reimbursement
- Maximum Units Policy on Hearing Aid BatteriesMaximum Units Policy on Hearing Aid Batteries
- Modifier JW – Drug WasteModifier JW – Drug Waste
- Modifier 22 – Increased Procedural ServicesModifier 22 – Increased Procedural Services
- Modifier 50 – Bilateral and LT/RTModifier 50 – Bilateral and LT/RT
- Modifier 52 – Reduced ServicesModifier 52 – Reduced Services
- Modifier 53 – Discontinued ProceduresModifier 53 – Discontinued Procedures
- Modifier 57 – Decision for SurgeryModifier 57 – Decision for Surgery
- Modifier 62 – Two SurgeonsModifier 62 – Two Surgeons
- Modifier 66- Surgical TeamModifier 66- Surgical Team
- Modifier 73 - Discontinued Outpatient Procedure Prior to the Administration of AnesthesiaModifier 73 - Discontinued Outpatient Procedure Prior to the Administration of Anesthesia
- Modifier 76- Repeat Procedure or Service by Same PhysicianModifier 76- Repeat Procedure or Service by Same Physician
- Modifier 77- Repeat Procedure or Service by Another PhysicianModifier 77- Repeat Procedure or Service by Another Physician
- Modifier 78 – Unplanned Return to the ORModifier 78 – Unplanned Return to the OR
- Modifiers 80, 81, 82 and AS – Assistant SurgeonModifiers 80, 81, 82 and AS – Assistant Surgeon
- Multiple Diagnostic Cardiovascular ProceduresMultiple Diagnostic Cardiovascular Procedures
- Multiple Diagnostic Ophthalmology ProceduresMultiple Diagnostic Ophthalmology Procedures
- Multiple Procedure ReductionMultiple Procedure Reduction
- Mutually and Non-Mutually Exclusive NCCI EditsMutually and Non-Mutually Exclusive NCCI Edits
- Ophthalmology ServicesOphthalmology Services
- Outpatient Facility Code Edits: Revenue CodesOutpatient Facility Code Edits: Revenue Codes
- Outpatient Services Prior to AdmissionOutpatient Services Prior to Admission
- Preventative Medicine Services with Auditory ScreeningPreventative Medicine Services with Auditory Screening
- Preventive Medicine ServicesPreventive Medicine Services
- PT/OT/ST ServicesPT/OT/ST Services
- Pulmonary Diagnostic Procedures when billed with Evaluation and Management CodesPulmonary Diagnostic Procedures when billed with Evaluation and Management Codes
- Self-Help/Peer Support Billing GuidelinesSelf-Help/Peer Support Billing Guidelines
- Smoking CessationSmoking Cessation
- Specimen Collection Travel AllowanceSpecimen Collection Travel Allowance
- Split Surgical Services (Modifiers -54, -55 and -56)Split Surgical Services (Modifiers -54, -55 and -56)
- Telemedicine and TelehealthTelemedicine and Telehealth
- Transitional Care PlanningTransitional Care Planning
- Ulcer Debridement and Ulcer StagesUlcer Debridement and Ulcer Stages
- Unlisted CodesUnlisted Codes
- Urgent Care Center Billing RequirementsUrgent Care Center Billing Requirements
- Urine Drug TestingUrine Drug Testing
- Health Services Policies – Clinical Affairs, Dental, Pharmacy, Quality, Utilization ManagementHealth Services Policies – Clinical Affairs, Dental, Pharmacy, Quality, Utilization Management
- Provider ManualProvider Manual
- Provider NewsletterProvider Newsletter
- State of New Jersey Contractual RequirementsState of New Jersey Contractual Requirements
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Timely Filing RequirementsTimely Filing Requirements
- Timely Filing Requirements
- Billing GuideBilling Guide
- Electronic Data Interchange (EDI)/Electronic Funds Transfer (EFT)Electronic Data Interchange (EDI)/Electronic Funds Transfer (EFT)
- Emdeon Electronic Funds Transfer (EFT) FormsEmdeon Electronic Funds Transfer (EFT) Forms
- Claims AddressesClaims Addresses
- ClaimsXTen FAQsClaimsXTen FAQs
- Tips for Claims/Encounters FilingTips for Claims/Encounters Filing
- NIA Claims MatrixNIA Claims Matrix
- False Claims PolicyFalse Claims Policy
- Utilization ManagementUtilization Management
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MLTSS Provider Manual TOCMLTSS Provider Manual TOC
- MLTSS Provider Manual TOC
- Section 1 - IntroductionSection 1 - Introduction
- Section 2 – EligibilitySection 2 – Eligibility
- Section 3 - MLTSS OverviewSection 3 - MLTSS Overview
- Section 4 - Care Management/AuthorizationsSection 4 - Care Management/Authorizations
- Section 5 - Billing GuideSection 5 - Billing Guide
- Section 6 - Grievance and Appeals ProcessSection 6 - Grievance and Appeals Process
- Section 7 - Service DepartmentsSection 7 - Service Departments
- Section 8 - Policies and ProceduresSection 8 - Policies and Procedures
- Appendix A – Glossary of TermsAppendix A – Glossary of Terms
- Appendix B – Contract ComplianceAppendix B – Contract Compliance
- Well-Being Screening ToolWell-Being Screening Tool
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ProgramsPrograms
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Horizon Behavioral Health℠Horizon Behavioral Health℠
- Horizon Behavioral Health℠
- About the Horizon Behavioral Health ProgramAbout the Horizon Behavioral Health Program
- Behavioral Health Training WebinarsBehavioral Health Training Webinars
- Credentialing & RecredentialingCredentialing & Recredentialing
- Demographic UpdatesDemographic Updates
- Medical Necessity CriteriaMedical Necessity Criteria
- Prior AuthorizationPrior Authorization
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Horizon NJ TotalCare (HMO D-SNP)Horizon NJ TotalCare (HMO D-SNP)
- Horizon NJ TotalCare (HMO D-SNP)
- Educational WebinarsEducational Webinars
- Cognitive ImpairmentCognitive Impairment
- Balance BillingBalance Billing
- FIDE-SNP Quick Reference GuideFIDE-SNP Quick Reference Guide
- Member BenefitsMember Benefits
- Medicaid EligibilityMedicaid Eligibility
- Model of CareModel of Care
- Critical IncidentsCritical Incidents
- HEDISHEDIS
- Results & Recognition ProgramResults & Recognition Program
- VRIVRI
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- Mom's GEMS Prenatal ProgramMom's GEMS Prenatal Program
- Office Based Addiction Treatment (OBAT) ProgramOffice Based Addiction Treatment (OBAT) Program
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Quality Improvement ProgramQuality Improvement Program
- Quality Improvement Program
- Results & Recognition ProgramResults & Recognition Program
- Smoking CessationSmoking Cessation
- HEDIS®HEDIS®
- CAHPS (Consumer Assessment of Healthcare Providers and Systems)CAHPS (Consumer Assessment of Healthcare Providers and Systems)
- Progress Toward HNJH’s GoalsProgress Toward HNJH’s Goals
- Hospital Acquired Conditions and Serious Adverse EventsHospital Acquired Conditions and Serious Adverse Events
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