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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
    • 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
    • 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
    • Reminder: Horizon NJ Health members are not responsible for PPE chargesReminder: Horizon NJ Health members are not responsible for PPE charges
    • 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
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      • MPPR Logic 2022MPPR Logic 2022
    • FAQ for MUE NotificationFAQ for MUE Notification
    • Federally Qualified Health Center (FQHC)Federally Qualified Health Center (FQHC)
      • Federally Qualified Health Center (FQHC)
      • 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
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    • Medicaid Reimbursement and BillingMedicaid Reimbursement and Billing
      • Medicaid Reimbursement and Billing
      • Medicaid Provider Enrollment Requirements by StateMedicaid Provider Enrollment Requirements by State
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      • 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
    • NJ Addiction Services HotlineNJ Addiction Services Hotline
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        • 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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        • Breast Pump ReimbursementBreast Pump Reimbursement
        • Cardiac Event DetectionCardiac Event Detection
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        • Chiropractic Manipulation Diagnosis PolicyChiropractic Manipulation Diagnosis Policy
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        • 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 Childbirth DeliveriesEarly Elective Childbirth Deliveries
        • 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
        • FIDE-SNP Hospital Sequestration ReimbursementFIDE-SNP Hospital Sequestration Reimbursement
        • 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
        • Hospice Room and Board ReimbursementHospice Room and Board Reimbursement
        • 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
        • Medical Nutrition TherapyMedical Nutrition Therapy
        • 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 Admission or Same Day SurgeryOutpatient Services Prior to Admission or Same Day Surgery
        • Post Payment Documentation Requests for Facility ClaimsPost Payment Documentation Requests for Facility Claims
        • Pre-Payment Documentation Requests for Facility ClaimsPre-Payment Documentation Requests for Facility Claims
        • 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
          • 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
        • 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
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        • Horizon Pulse - 2021Horizon Pulse - 2021
          • Horizon Pulse - 2021
          • Horizon Pulse December 2021Horizon Pulse December 2021
          • Horizon Pulse June 2021Horizon Pulse June 2021
          • Horizon Pulse 2021, Issue 1Horizon Pulse 2021, Issue 1
        • Horizon Pulse - OlderHorizon Pulse - Older
      • Horizon Pulse March 2022Horizon Pulse March 2022
    • State of New Jersey Contractual RequirementsState of New Jersey Contractual Requirements
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      • Surgical and Implantable Device Management Program
      • Cardiac ServicesCardiac Services
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      • Managed Long Term Services and Supports
      • WelcomeWelcome
      • MLTSS Service DictionaryMLTSS Service Dictionary
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    • Mom's GEMS Prenatal ProgramMom's GEMS Prenatal Program
    • New Jersey Integrated Care for Kids (NJ InCK)New Jersey Integrated Care for Kids (NJ InCK)
    • Office Based Addiction Treatment (OBAT) ProgramOffice Based Addiction Treatment (OBAT) Program
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      • For Providers: 1-800-682-9091
    • Pre-Certification/Prior Authorization requirements for Post-Acute Facility Admissions
    • Submitting Pharmacy Claims for OTC, At-Home COVID-19 Test Kits
    • Submitting Pharmacy Claims for COVID-19 Vaccinations
    • Antibody testing: FDA and CDC do not recommend use to determine immunity
    • Reminder: Use correct codes when evaluating for COVID-19
    • Policy Update: Antibody Testing Claims
    • Submitting claims for COVID-19 vaccines delivered in non-traditional medical settings
    • For Essential Workers, COVID-19 Treatment Covered Under Workers' Compensation Benefits
    • COVID-19 Vaccine
    • COVID-19 vaccines will be covered at 100%
    • Coverage for antibody infusion therapy
    • Reminder: Horizon NJ Health members are not responsible for PPE charges
    • COVID-19 Frequently Asked Questions
    • Reminder to use specific codes when evaluating for COVID-19
    • Referrals no longer required for in-network specialists
    • Telemedicine and Telehealth Services Reimbursement Policy
  • Resources
      • For Providers: 1-800-682-9091
    • 21st Century Cures Act
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Federally Qualified Health Center (FQHC) - Horizon NJ Health

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COVID-19
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  • 21st Century Cures Act
  • Advance Directives
  • ASAM Criteria for Patients and Families
  • Leading the Way on Lead
  • Clinical and Preventive Guidelines
    • Clinical Guidelines
  • Credentialing and Recredentialing Responsibilities
    • Credentialing and Recredentialing Policy for Participating Physicians and Healthcare Professionals
    • Credentialing and Recredentialing Policy for Ancillary and Managed Long Term Support Service (MLTSS) Providers
  • Cultural Competency
  • Demographic Updates
  • Educational Material for Providers
    • ClaimsXTen FAQs
    • ClaimsXTen Edit Codes and Messages
    • SimpleClaim Training Resources
    • How to Correctly Submit Claims with J or Q Codes
  • Educational Webinars
  • eviCore healthcare
    • Contrast Agents and Radiopharmaceuticals Medicaid 2022
    • MPPR Logic 2020
    • MPPR Logic 2021
    • MPPR Logic 2022
  • FAQ for MUE Notification
  • Federally Qualified Health Center (FQHC)
    • Federally Qualified Health Center (FQHC) Resource Guide
    • Federally Qualified Health Center (FQHC) - Dental Billing Guide
    • DAVIS VISION Federally Qualified Health Center (FQHC) – Vision Billing Guide
  • Forms
    • Behavioral Health Forms
    • Clinical Authorization Forms
    • COVID Vaccine Form
    • Early and Periodic Screening, Diagnosis and Treatment Exam Forms
    • Electronic Funds Transfer (EFT) Forms
    • Forms to Join Our Networks
    • Lead Risk Assessment Form
    • OBAT Attestation for Nonparticipating Providers
    • Other Forms
  • Guides
  • Health Literacy
  • HealthSphere
  • Laboratory Corporation of America (LabCorp)
    • LabCorp Alert and Panic Results Policy
    • LabCorp Connectivity Solutions
    • LabCorp introduces RoadNet®
    • LabCorp Beacon: Patient
    • NuSwab: Candida and STD testing
  • Medicaid Reimbursement and Billing
    • Medicaid Provider Enrollment Requirements by State
    • Horizon NJ Health Foot Orthotic Shoes and Inserts Reimbursement Policy
  • MLTSS Bed Type Revenue Codes
  • MLTSS Orientation
  • MLTSS Provider Manual
    • Section 1 - Introduction
    • Section 2 – Eligibility
    • Section 3 - MLTSS Overview
    • Section 4 - Care Management/Authorizations
    • Section 5 - Billing Guide
    • Section 6 - Grievance and Appeals Process
    • Section 7 - Service Departments
    • Section 8 - Policies and Procedures
    • Appendix A – Glossary of Terms
    • Appendix B – Contract Compliance
  • NJ Addiction Services Hotline
  • Pharmacy Utilization Management Programs
    • Pharmacy Medical Necessity Determination
    • Maximum Allowable Cost (MAC) Appeal Form
  • Policies
    • Medical Policies
    • Digital Member ID Card Policy
    • Reimbursement Policies & Guidelines
      • Add-on Payment for COVID-19 Diagnostic Testing Run on High Throughput Technology (U0005)
      • Advance Care Planning
      • Allergy Services
      • Ambulance Services
      • Anesthesia Reimbursement Guidelines
      • Billing Requirements for Clinical Trials
      • Brachytherapy Billing Requirements
      • Breast Pump Reimbursement
      • Cardiac Event Detection
      • Care Management Services for Substance Use Disorders
      • Centering Pregnancy Prenatal Care
      • Chiropractic Manipulation Diagnosis Policy
      • Chronic Care Management
      • Claim Editing Policy
      • Consultation Services Payment
      • COVID 19 Antibody Testing
      • Daily Maximum Units for Surgical Pathology and Microscopic Examination
      • Diabetic Screening Services
      • DIR Services
      • Distinct Procedural Service Modifiers (59, XE, XP, XS, XU)
      • Doula Services
      • Early Elective Childbirth Deliveries
      • Endoscopic Retrograde Cholangiopancreatography (ERCP)
      • Evaluation and Management Services billed with Global Radiology, Stress Test, Stress Echo or Myocardial Profusion Imaging
      • False Claims
      • FIDE-SNP Hospital Sequestration Reimbursement
      • Foot Orthotic Shoes and Inserts
      • Free Flap Breast Reconstruction
      • Frequency of Ocular Photography
      • Home Health Certification and Re-Certification
      • Hospice Room and Board Reimbursement
      • Laboratory Services Billed by Physicians
      • Maternity Reimbursement
      • Maximum Units Policy on Hearing Aid Batteries
      • Medical Nutrition Therapy
      • Modifier JW – Drug Waste
      • Modifier 22 – Increased Procedural Services
      • Modifier 50 – Bilateral and LT/RT
      • Modifier 52 – Reduced Services
      • Modifier 53 – Discontinued Procedures
      • Modifier 57 – Decision for Surgery
      • Modifier 62 – Two Surgeons
      • Modifier 66- Surgical Team
      • Modifier 73 - Discontinued Outpatient Procedure Prior to the Administration of Anesthesia
      • Modifier 76- Repeat Procedure or Service by Same Physician
      • Modifier 77- Repeat Procedure or Service by Another Physician
      • Modifier 78 – Unplanned Return to the OR
      • Modifiers 80, 81, 82 and AS – Assistant Surgeon
      • Multiple Diagnostic Cardiovascular Procedures
      • Multiple Diagnostic Ophthalmology Procedures
      • Multiple Procedure Reduction
      • Mutually and Non-Mutually Exclusive NCCI Edits
      • Ophthalmology Services
      • Outpatient Facility Code Edits: Revenue Codes
      • Outpatient Services Prior to Admission or Same Day Surgery
      • Post Payment Documentation Requests for Facility Claims
      • Pre-Payment Documentation Requests for Facility Claims
      • Preventative Medicine Services with Auditory Screening
      • Preventive Medicine Services
      • PT/OT/ST Services
      • Pulmonary Diagnostic Procedures when billed with Evaluation and Management Codes
      • Self-Help/Peer Support Billing Guidelines
      • Smoking Cessation
      • Specimen Collection Travel Allowance
      • Split Surgical Services (Modifiers -54, -55 and -56)
      • Telemedicine and Telehealth
        • Telemedicine Reimbursement Policy: Temporary Update
      • Transitional Care Planning
      • Ulcer Debridement and Ulcer Stages
      • Unlisted Codes
      • Urgent Care Center Billing Requirements
      • Urine Drug Testing
    • Health Services Policies – Clinical Affairs, Dental, Pharmacy, Quality, Utilization Management
  • Provider Manual
  • Provider Newsletter
    • Archives
      • Horizon Pulse - 2021
        • Horizon Pulse December 2021
        • Horizon Pulse June 2021
        • Horizon Pulse 2021, Issue 1
      • Horizon Pulse - Older
    • Horizon Pulse March 2022
  • State of New Jersey Contractual Requirements
  • Surgical and Implantable Device Management Program
    • Cardiac Services
    • Orthopedic Services
    • Spine Services
  • Timely Filing Requirements
    • Billing Guide
    • Electronic Data Interchange (EDI)/Electronic Funds Transfer (EFT)
    • Emdeon Electronic Funds Transfer (EFT) Forms
    • Claims Addresses
    • ClaimsXTen FAQs
    • Tips for Claims/Encounters Filing
    • NIA Claims Matrix
    • False Claims Policy
  • Utilization Management
    • Utilization Management Appeal Process for Administrative Denials
  • Well-Being Screening Tool
COVID-19
Stay informed.
Get the latest information on COVID-19.

Federally Qualified Health Center (FQHC)

Federally Qualified Health Center (FQHC) Resource Guide

Federally Qualified Health Center (FQHC) - Dental Billing Guide

DAVIS VISION Federally Qualified Health Center (FQHC) – Vision Billing Guide

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