Tips for Claims/Encounters Filing

Ensure all required and conditional data elements are populated on the CMS 1500 form or UB-04 as outlined in section 9.0 of the Physician and Health Care Professional Manual.

  • Use the most current CPT and ICD-10 codes when submitting claims to Horizon NJ Health.
    • Please note that the fourth or fifth digits must be included in the diagnosis code if required or the claim will deny for invalid diagnosis code.
    • All diagnosis codes relevant to that member should be on the claims.
  • Use appropriate coding for Pediatric preventive care visits. There is an enhanced payment for the provision of Early and Periodic Screening, Diagnosis and Treatment (EPSDT) services. 
  • When submitting claims/encounters for treatment of high-risk members, utilize the diagnosis code appropriate to those members that captures all the diagnosis relevant to that member.