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COVID-19 InformationCOVID-19 Information
- COVID-19 Information
- Reminder: Horizon NJ Health members are not responsible for PPE chargesReminder: Horizon NJ Health members are not responsible for PPE charges
- Update: Waiving cost share for telemedicine and COVID-19 treatment extendedUpdate: Waiving cost share for telemedicine and COVID-19 treatment extended
- Update: Automatic Extension of Private Duty Nursing AuthorizationsUpdate: Automatic Extension of Private Duty Nursing Authorizations
- Teledentistry reminderTeledentistry reminder
- Automatic Extension of Private Duty Nursing AuthorizationsAutomatic Extension of Private Duty Nursing Authorizations
- Dates for Certain Prior Authorization Waivers Further ExtendedDates for Certain Prior Authorization Waivers Further Extended
- Guidance for Dentists and Staff on Reopening Dental Offices During the COVID-19 Pandemic (May 22, 2020)Guidance for Dentists and Staff on Reopening Dental Offices During the COVID-19 Pandemic (May 22, 2020)
- Providing teledentistry for Horizon NJ Health members during COVID-19Providing teledentistry for Horizon NJ Health members during COVID-19
- Dates for Prior Authorization Waivers ExtendedDates for Prior Authorization Waivers Extended
- Use Modifier CS to Identify Services Subject to Cost Share WaiverUse Modifier CS to Identify Services Subject to Cost Share Waiver
- New Laboratory COVID-19 Antibody Testing Codes: 86328 and 86769New Laboratory COVID-19 Antibody Testing Codes: 86328 and 86769
- Extending Prior Authorizations for Private Duty NursesExtending Prior Authorizations for Private Duty Nurses
- Help for health care professionalsHelp for health care professionals
- COVID-19 Update: Medical Policy Revisions & ImplementationsCOVID-19 Update: Medical Policy Revisions & Implementations
- 72 Doctors, Nurses, Pharmacists and Health Clinicians from Horizon BCBSNJ Answer Governor Murphy’s “HealthCare Professionals Call to Serve”72 Doctors, Nurses, Pharmacists and Health Clinicians from Horizon BCBSNJ Answer Governor Murphy’s “HealthCare Professionals Call to Serve”
- New Jersey Pandemic Relief Fund Efforts Get $2 Million Boost from HorizonNew Jersey Pandemic Relief Fund Efforts Get $2 Million Boost from Horizon
- A special message from Howard A. Cutler, Vice President, Healthcare DeliveryA special message from Howard A. Cutler, Vice President, Healthcare Delivery
- Behavioral Health Continuity During the COVID-19 Public Health EmergencyBehavioral Health Continuity During the COVID-19 Public Health Emergency
- COVID-19 Frequently Asked QuestionsCOVID-19 Frequently Asked Questions
- Members Will Incur No Costs for Treatment of COVID-19Members Will Incur No Costs for Treatment of COVID-19
- Waiving Pre-Certification/Prior Authorization requirements for Physical Health Post-Acute Facility AdmissionsWaiving Pre-Certification/Prior Authorization requirements for Physical Health Post-Acute Facility Admissions
- Horizon BCBSNJ Commits $2.5 Million for Masks, Face Shields, Food and Social Services to Protect Our Communities and Our Health ProfessionalsHorizon BCBSNJ Commits $2.5 Million for Masks, Face Shields, Food and Social Services to Protect Our Communities and Our Health Professionals
- Reminder to use specific codes when evaluating for COVID-19Reminder to use specific codes when evaluating for COVID-19
- Administrative Policy: Credentialing and Recredentialing During the COVID-19 PandemicAdministrative Policy: Credentialing and Recredentialing During the COVID-19 Pandemic
- Waiving Pre-Certification/Prior Authorization requirements for acute inpatient facility admissionsWaiving Pre-Certification/Prior Authorization requirements for acute inpatient facility admissions
- Referrals no longer required for in-network specialistsReferrals no longer required for in-network specialists
- Governor suspends all elective proceduresGovernor suspends all elective procedures
- 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
- COVID-19 CPT testing codesCOVID-19 CPT testing codes
- State of Emergency and Public Health Emergency – Office ClosuresState of Emergency and Public Health Emergency – Office Closures
- Telemedicine and Telehealth Services Reimbursement PolicyTelemedicine and Telehealth Services Reimbursement Policy
- Eliminating Cost Sharing Related to COVID-19 Testing and EvaluationEliminating Cost Sharing Related to COVID-19 Testing and Evaluation
- Staying Informed: COVID-19 (Coronavirus)Staying Informed: COVID-19 (Coronavirus)
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ResourcesResources
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- Adolescent Risk Behaviors and Depression PIP HandbookAdolescent Risk Behaviors and Depression PIP Handbook
- Advance DirectivesAdvance Directives
- ASAM Criteria for Patients and FamiliesASAM Criteria for Patients and Families
- Clinical and Preventive GuidelinesClinical and Preventive Guidelines
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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
- Cultural CompetencyCultural Competency
- Demographic updatesDemographic updates
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Educational Material for ProvidersEducational Material for Providers
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- ClaimsXTen FAQsClaimsXTen FAQs
- ClaimsXTen Edit Codes and MessagesClaimsXTen Edit Codes and Messages
- CareAffiliate TrainingCareAffiliate Training
- SimpleClaim Training ResourcesSimpleClaim Training Resources
- How to Correctly Submit Claims with J or Q CodesHow to Correctly Submit Claims with J or Q Codes
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- FAQ for MUE NotificationFAQ for MUE Notification
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FormsForms
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- Age - Appropriate EPSDT FormsAge - Appropriate EPSDT Forms
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- Physical Therapist, Occupational Therapist, Speech TherapistPhysical Therapist, Occupational Therapist, Speech Therapist
- Electronic Funds Transfer (EFT) FormsElectronic Funds Transfer (EFT) Forms
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- Lead Risk AssessmentLead Risk Assessment
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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<sup>®</sup>LabCorp introduces RoadNet<sup>®</sup>
- 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
- MLTSS OrientationMLTSS Orientation
- MUE Rule Notification Letter MedicaidMUE Rule Notification Letter Medicaid
- NJ Addiction Services HotlineNJ Addiction Services Hotline
- Pharmacy Utilization Management ProgramsPharmacy Utilization Management Programs
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PoliciesPolicies
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Reimbursement Policies & GuidelinesReimbursement Policies & Guidelines
- Reimbursement Policies & Guidelines
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- Ambulance ServicesAmbulance Services
- Billing Requirements for Clinical TrialsBilling Requirements for Clinical Trials
- Centering Pregnancy Prenatal CareCentering Pregnancy Prenatal Care
- Chiropractic Manipulation Diagnosis PolicyChiropractic Manipulation Diagnosis Policy
- Claim Editing PolicyClaim Editing Policy
- Daily Maximum Units for Surgical Pathology and Microscopic ExaminationDaily Maximum Units for Surgical Pathology and Microscopic Examination
- Diabetic Screening ServicesDiabetic Screening Services
- 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
- Foot Orthotic Shoes and InsertsFoot Orthotic Shoes and Inserts
- Frequency of Ocular PhotographyFrequency of Ocular Photography
- Laboratory Services Billed by PhysiciansLaboratory Services Billed by Physicians
- 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 54 – Surgical Care OnlyModifier 54 – Surgical Care Only
- Modifier 55 – Postoperative Management OnlyModifier 55 – Postoperative Management Only
- Modifier 56 – Preoperative Management OnlyModifier 56 – Preoperative Management Only
- Modifier 57 – Decision for SurgeryModifier 57 – Decision for Surgery
- Modifier 62 – Two SurgeonsModifier 62 – Two Surgeons
- Modifier 66- Surgical TeamModifier 66- Surgical Team
- 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 Procedure ReductionMultiple Procedure Reduction
- Multiple Procedure Payment Reduction for EndoscopiesMultiple Procedure Payment Reduction for Endoscopies
- Mutually and Non-Mutually Exclusive NCCI EditsMutually and Non-Mutually Exclusive NCCI Edits
- Preventive Medicine ServicesPreventive Medicine Services
- Preventative Medicine Services with Auditory ScreeningPreventative Medicine Services with Auditory Screening
- Pulmonary Diagnostic Procedures when billed with Evaluation and Management CodesPulmonary Diagnostic Procedures when billed with Evaluation and Management Codes
- Readmission Policy (Medicaid)Readmission Policy (Medicaid)
- Readmission Policy (Medicaid) – FAQReadmission Policy (Medicaid) – FAQ
- Telemedicine and TelehealthTelemedicine and Telehealth
- Transitional Care PlanningTransitional Care Planning
- Ulcer Debridement and Ulcer StagesUlcer Debridement and Ulcer Stages
- 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
- Well-Being Screening ToolWell-Being Screening Tool
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ProgramsPrograms
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- DentalDental
- Disease Management Programs to Help Your PatientsDisease Management Programs to Help Your Patients
- Education OpportunitiesEducation Opportunities
- Fluoride Varnish Pediatric ApplicationFluoride Varnish Pediatric Application
- Focus on Risk AdjustmentFocus on Risk Adjustment
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Horizon Behavioral Health℠Horizon Behavioral Health℠
- Horizon Behavioral Health℠
- About the Horizon Behavioral Health ProgramAbout the Horizon Behavioral Health Program
- Credentialing & RecredentialingCredentialing & Recredentialing
- Demographic UpdatesDemographic Updates
- Medical Necessity CriteriaMedical Necessity Criteria
- Prior AuthorizationPrior Authorization
- Frequently Asked QuestionsFrequently Asked Questions
- External ResourcesExternal Resources
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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
- Managed Long Term Services and SupportsManaged Long Term Services and Supports
- Mom's GEMS Prenatal ProgramMom's GEMS Prenatal Program
- Office Based Addiction Treatment (OBAT) ProgramOffice Based Addiction Treatment (OBAT) Program
- Primary Care Physician ProgramPrimary Care Physician 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
- Provider RecruitmentProvider Recruitment
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