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  • COVID-19 InformationCOVID-19 Information
    • COVID-19 Information
    • New Update for Automatic Extension of Private Duty Nursing AuthorizationsNew Update for Automatic Extension of Private Duty Nursing Authorizations
    • Update: Members Will Incur No Costs for Treatment of COVID-19 through 2020Update: Members Will Incur No Costs for Treatment of COVID-19 through 2020
    • Update: Antibody Testing ClaimsUpdate: Antibody Testing Claims
    • 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
    • Teledentistry reminderTeledentistry reminder
    • 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
    • New Laboratory COVID-19 Antibody Testing Codes: 86328 and 86769New Laboratory COVID-19 Antibody Testing Codes: 86328 and 86769
    • 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)
  • ResourcesResources
    • Resources
    • 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
      • Clinical and Preventive Guidelines
      • Clinical GuidelinesClinical Guidelines
    • 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
    • Educational Material for ProvidersEducational Material for Providers
      • Educational Material for Providers
      • 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
    • eviCore healthcareeviCore healthcare
    • FAQ for MUE NotificationFAQ for MUE Notification
    • FormsForms
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      • Behavioral HealthBehavioral Health
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      • Physical Therapist, Occupational Therapist, Speech TherapistPhysical Therapist, Occupational Therapist, Speech Therapist
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      • Lead Risk AssessmentLead Risk Assessment
    • GuidesGuides
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      • Tips and ToolsTips and Tools
    • 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
      • Medicaid Reimbursement and Billing
      • Medicaid Provider Enrollment Requirements by StateMedicaid Provider Enrollment Requirements by State
      • Horizon NJ Health Foot Orthotic Shoes and Inserts Reimbursement PolicyHorizon NJ Health Foot Orthotic Shoes and Inserts Reimbursement Policy
    • 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
      • Pharmacy Utilization Management Programs
      • Pharmacy Medical Necessity DeterminationPharmacy Medical Necessity Determination
      • Maximum Allowable Cost (MAC) Appeal FormMaximum Allowable Cost (MAC) Appeal Form
    • PoliciesPolicies
      • Policies
      • Medical PoliciesMedical Policies
      • Reimbursement Policies & GuidelinesReimbursement Policies & Guidelines
        • Reimbursement Policies & Guidelines
        • Advance Care PlanningAdvance Care Planning
        • Allergy ServicesAllergy Services
        • 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
        • Chronic Care ManagementChronic Care Management
        • 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
        • Home Health Certification and Re-CertificationHome Health Certification and Re-Certification
        • 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
        • 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
        • Readmission Policy (Medicaid)Readmission Policy (Medicaid)
        • Readmission Policy (Medicaid) – FAQReadmission Policy (Medicaid) – FAQ
        • Telemedicine and TelehealthTelemedicine and Telehealth
          • Telemedicine and Telehealth
          • Telemedicine Reimbursement Policy: Temporary UpdateTelemedicine Reimbursement Policy: Temporary Update
        • 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
    • 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
      • Utilization Management
      • eviCoreeviCore
      • Precertification Reference ListPrecertification Reference List
      • Utilization Management Appeal Process for Administrative DenialsUtilization Management Appeal Process for Administrative Denials
    • Well-Being Screening ToolWell-Being Screening Tool
  • ProgramsPrograms
    • Programs
    • Care ManagementCare Management
    • DentalDental
      • Dental
      • Caries Risk AssessmentCaries Risk Assessment
      • Noncompliant membersNoncompliant members
      • Prior AuthorizationPrior Authorization
      • Role of the Managed Care Organization (MCO)Role of the Managed Care Organization (MCO)
      • SKYGEN USASKYGEN USA
    • Disease Management Programs to Help Your PatientsDisease Management Programs to Help Your Patients
      • Disease Management Programs to Help Your Patients
      • Program for Elderly MembersProgram for Elderly Members
    • Education OpportunitiesEducation Opportunities
    • Fluoride Varnish ProgramFluoride Varnish Program
    • Focus on Risk AdjustmentFocus on Risk Adjustment
    • Horizon Behavioral Health&#8480;Horizon Behavioral Health&#8480;
      • Horizon Behavioral Health&#8480;
      • 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
    • 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
      • Managed Long Term Services and Supports
      • WelcomeWelcome
      • MLTSS Service DictionaryMLTSS Service Dictionary
      • MLTSS Critical Incident ReportingMLTSS Critical Incident Reporting
    • 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
    • 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
    • Provider Recruitment
    • Join the Horizon NJ Health Provider NetworkJoin the Horizon NJ Health Provider Network
    • Ancillary Application RequestAncillary Application Request
  • NewsNews
    • News
    • Updates and AnnouncementsUpdates and Announcements
  • FIND A DOCTOR
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  • COVID-19 Information
      • For Providers: 1-800-682-9091

    • New Update for Automatic Extension of Private Duty Nursing Authorizations

      Update: Members Will Incur No Costs for Treatment of COVID-19 through 2020

      Update: Antibody Testing Claims

      Update: Cost-share waiver for telemedicine and COVID-19 testing extended

      Reminder: Horizon NJ Health members are not responsible for PPE charges

      Teledentistry reminder

      Dates for Certain Prior Authorization Waivers Further Extended

      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-19

      Dates for Prior Authorization Waivers Extended

      New Laboratory COVID-19 Antibody Testing Codes: 86328 and 86769

      Help for health care professionals

      COVID-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”

      New Jersey Pandemic Relief Fund Efforts Get $2 Million Boost from Horizon

      A special message from Howard A. Cutler, Vice President, Healthcare Delivery

      Behavioral Health Continuity During the COVID-19 Public Health Emergency

      COVID-19 Frequently Asked Questions

      Members Will Incur No Costs for Treatment of COVID-19

      Waiving 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 Professionals

      Reminder to use specific codes when evaluating for COVID-19

      Administrative Policy: Credentialing and Recredentialing During the COVID-19 Pandemic

      Waiving Pre-Certification/Prior Authorization requirements for acute inpatient facility admissions

      Referrals no longer required for in-network specialists

      Governor suspends all elective procedures

      Providing telephonic care with no costs to members

      COVID-19 Response: Eliminating Cost-Sharing for Qualified In-Network Telemedicine Services

      COVID-19 CPT testing codes

      State of Emergency and Public Health Emergency – Office Closures

      Telemedicine and Telehealth Services Reimbursement Policy

      Eliminating Cost Sharing Related to COVID-19 Testing and Evaluation

      Staying Informed: COVID-19 (Coronavirus)

  • Resources
      • For Providers: 1-800-682-9091

    • Adolescent Risk Behaviors and Depression PIP Handbook

      Advance Directives

      ASAM Criteria for Patients and Families

      Clinical and Preventive Guidelines

      Credentialing and Recredentialing Responsibilities

      Cultural Competency

      Demographic updates

      Educational Material for Providers

      eviCore healthcare

      FAQ for MUE Notification

      Forms

      Guides

      Health Literacy

      Laboratory Corporation of America (LabCorp)

      Medicaid Reimbursement and Billing

      MLTSS Bed Type Revenue Codes

      MLTSS Non-Medical Professional Provider Manual

      MLTSS Orientation

      MUE Rule Notification Letter Medicaid

      NJ Addiction Services Hotline

      Pharmacy Utilization Management Programs

      Policies

      Provider Manual

      Provider Newsletter

      State of New Jersey Contractual Requirements

      Timely Filing Requirements

      Utilization Management

      Well-Being Screening Tool

  • Programs
      • For Providers: 1-800-682-9091

    • Care Management

      Dental

      Disease Management Programs to Help Your Patients

      Education Opportunities

      Fluoride Varnish Program

      Focus on Risk Adjustment

      Horizon Behavioral Health℠

      Horizon NJ TotalCare (HMO D-SNP)

      Managed Long Term Services and Supports

      Mom's GEMS Prenatal Program

      Office Based Addiction Treatment (OBAT) Program

      Primary Care Physician Program

      Quality Improvement Program

  • Provider Recruitment
      • For Providers: 1-800-682-9091

    • Join the Horizon NJ Health Provider Network

      Ancillary Application Request

  • News
      • For Providers: 1-800-682-9091

    • Updates and Announcements

Updates and Announcements - Horizon NJ Health

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COVID-19
Stay informed.Get the latest information on COVID-19.
Updates and Announcements
COVID-19
Stay informed.
Get the latest information on COVID-19.

Updates and Announcements

Posted on October 16, 2020

Quarterly Roundtable Discussions for Horizon NJ Health Specialty Practices

Posted on October 15, 2020

Reimbursement Policy: Outpatient Services Prior to Admission

Posted on October 14, 2020

Reimbursement Policy: Home Health Certification and Re-Certification

Posted on October 12, 2020

Resources available to help support your vaccination efforts

Posted on October 8, 2020

Change to the Precertification Post-Acute Facility Intake Requests Submission Process

Posted on October 7, 2020

Reimbursement Policy: Chronic Care Management

Posted on October 6, 2020

Reimbursement Policy: PT/OT/ST Services

Posted on October 4, 2020

Recredentialing vendor update

Posted on October 1, 2020

New Post-Acute Facility Prior Authorization Process for Medicare Advantage and Horizon NJ TotalCare (HMO D-SNP) Members

Posted on October 1, 2020

New Post-Acute Facility Prior Authorization Process for Medicare Advantage and Horizon NJ TotalCare (HMO D-SNP) Members

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Products are provided by Horizon NJ Health. Communications are issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and provider relations for all its companies. Both are independent licensees of the Blue Cross and Blue Shield Association.
The Blue Cross® and Blue Shield® names and symbols are registered marks of the Blue Cross and Blue Shield Association. The Horizon® name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey.

 

© 2020 Horizon Blue Cross Blue Shield of New Jersey, Three Penn Plaza East, Newark, New Jersey 07105.

 

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