Hospitals & Ancillary Providers

To ensure bills are paid correctly and in a timely manner, bills must be submitted within the time frame specified in the Hospital or Ancillary Provider Agreement or by law.

Hospitals, health care professionals, and facilities that are exempt from the state's mandate must follow these simple instructions to avoid payment delays:

Itemize services using Revenue Codes, HCPCS and CPT®-4 codes, where applicable.
Submit charges on original red and white UB04 claim forms.
Billed charges must reflect the hospital’s usual and customary charges.
Attach copies of related medical records to the submission and mail to:

Horizon Casualty Services, Inc.
PO Box 10175
Newark, NJ 07101-3175

Coding and reporting of services must be in accordance with standard coding practices that are consistent with the Centers for Medicare & Medicaid (CMS) National Correct Coding Initiatives (NCCI).

Reimbursement Guidelines

Workers’ compensation bills are processed according to the terms and conditions in the contract. Reimbursement of billed services may be issued by the claimant’s insurer or the TPA. Reimbursement of billed services for State of New Jersey claimants is issued by HCS.

Hospitals and providers may call HCS at 1-800-985-7777 for reimbursement status of previously submitted bills.

For PIP claims, HCS processes bills received from participating hospitals and ancillary providers according to the terms and conditions in the Hospital or Ancillary Provider Agreement and the State of New Jersey PIP Regulations.

The PIP insurers’ limit of liability for any medical expense benefit shall be the amounts identified in the New Jersey PIP Fee Schedule (N.J.A.C. 11:3-29).

Reimbursement for billed services is issued by the PIP insurer. Untimely reimbursement of PIP bills may be subject to interest payments.

For more information about the New Jersey PIP regulations or to access the New Jersey PIP Fee Schedule, read PIP Information for Health Care Providers.

Refunds & Overpayments

In cases where an overpayment has been made, hospitals and providers are expected to issue a refund of the overpayment within 90 days of notification of the amount owed. HCS will only seek reimbursement of a bill overpayment from the hospital or provider within 18 months from the date the bill was paid.

To obtain information about electronic billing, please contact the EDI Service Desk toll-free at 1-888-334-9242 or email Horizonedi@HorizonBlue.com. Representatives are available weekdays from 7 a.m. to 6 p.m.

CPT® is a registered mark of the American Medical Association.