Horizon NJ Health
210 Silvia Street
West Trenton, NJ 08628
Phone: (609) 718-9001
horizonNJhealth.com




Independent licensees of the Blue Cross and Blue Shield Association* CMC0010053
Horizon NJ Health, a product of Horizon HMO*

<<date>>

Dear Provider,

Horizon NJ Health is sending you a reminder about the correct bed type and revenue codes you
should be billing for the Managed Long Term Services and Supports (MLTSS) program as well
as non-MLTSS services provided in a nursing facility or day program.

Please use the grid below as a guide when billing nursing facility claims to Horizon NJ Health.
The room types you cite on your daily logs will correspond to an appropriate revenue code for
billing purposes. By following this guide it will help reduce the number of denials you receive on
your claims submissions.


Bed/Room Type Description Revenue Codes
NH MLTSS Nursing Home 0100, 0119, 0129, 0139, 0149, 0159, 0169 with

bill type 21X
OS MLTSS SCNF 0100, 0119, 0129, 0139, 0149, 0159, 0169 with

bill type 65X or 66X
R7 Respite Care 0663
MN Non-MLTSS Nursing

Home
0101

SK Rehab Day - Skilled 0191
RS Rehab Day ? Sub

Acute
0192

RN Rehab Day ? Complex 0193
RV Rehab Day - Ventilator 0199
NM Non MLTSS SCNF 0160


If you have any questions or concerns, please contact Lori Jackson at
Lori_Jackson@HorizonBlue.com. You can also find useful information and tools on
horizonNJhealth.com.


Sincerely,



Theodore Pantaleo
Director, Network Contracting and Strategy