MUE Rule Notification Letter Medicaid

Tikka Attach

Horizon NJ Health

210 Silvia Street

West Trenton, NJ 08628

Phone: (609) 718-9001

Independent licensees of the Blue Cross and Blue Shield Association* CMC0010209A

Horizon NJ Health, a product of Horizon HMO*


Dear Provider,

Horizon NJ Health will be making some modifications and enhancements to our claim editing

rules that may affect the reporting, status and payment of your claims. The claim editing rules

followed by Horizon NJ Health are based on the Centers for Medicare & Medicaid Services'

(CMS) National Correct Coding Initiative (NCCI) regarding Medically Unlikely Edits (MUE).

Information on the CMS MUE details can be found on

We are enhancing claim edits related to MUEs for Horizon NJ TotalCare (HMO SNP) &

Medicaid claims. The MUE edits for practitioners and durable medical equipment (DME)

suppliers will be effective for claims with a date of service of October 8, 2017 and beyond. We

would also like to remind you of changes we made for outpatient hospital claims with a date of

service of January 1, 2017 or after.

More information about the changes is contained in an FAQ on our website at We will also be holding some informational

Webinars where we will discuss these changes and answer any questions you may have. We will

be sending you information about these sessions, which will also be available on

Thank you very much for your attention to this matter.


Theodore Pantaleo

Director, Provider Contracting and Strategy