Electronic Data Interchange (EDI)/Electronic Funds Transfer (EFT)

Horizon NJ Health encourages all hospitals, physicians and health care professionals to submit claims electronically. For those interested in electronic claim filing, please call TriZetto Trading Partners Solutions (TTPS) at 1-800-556-2231, Monday to Friday, from 8 a.m. to 7 p.m. ET, or email to obtain more information. For more information on EDI, review Section 9.3, Procedures for Electronic Submission — Electronic Data Interchange in the Provider Administrative Manual.

EDI allows faster, more efficient and cost-effective claim submission for hospitals, physicians and health care professionals. EDI, performed in accordance with nationally recognized standards, supports the industry’s efforts to reduce overhead administrative costs.

The benefits of billing electronically include:

  • Reduction of overhead and administrative costs
    • - EDI eliminates the need for paper claims submission. It has also been proven to reduce claim re-work (adjustments).
  • Receipt of reports as proof of claim receipt
    • - This makes it easier to track the status of claims.
  • Faster transaction time for claims submitted electronically
    • - An EDI claim averages about 24 to 48 hours from the time it is sent to the time it is received. This enables providers to easily track their claims.
  • Validation of data elements on the claim
    • - By the time a claim is successfully received electronically, information needed for processing is present. This reduces the chance of data entry errors that occur when completing paper claim forms.
  • Quicker claim completion
    • - Claims that do not need additional investigation are generally processed quicker. Reports have shown that a large percentage of EDI claims are processed within 10 to 15 days of their receipt.

Horizon NJ Health issues provider reimbursements for Medicaid/NJ FamilyCare members twice a week. Reimbursement for services provided to Horizon NJ TotalCare (HMO SNP) members are issued on a weekly basis.

Should you have questions regarding billing, please contact Provider Services at 1-800-682-9091.

Horizon NJ Health does not accept handwritten claims – including those with signatures or other markings – or black and white claims.