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Physicians & Other Health Care Professionals

Providers who are exempt from the Electronic Medical Bill Rule must bill on a CMS 1500 form and follow these simple instructions to avoid payment delays:

  1. Itemize services using CPT-4 and diagnosis codes on a CMS-1500 (HCFA-1500) original red and white claim form. Confirm that all information is accurate and complete. Be sure to include the patient’s claim number.
  2. Physicians and other health care professionals must submit their usual and customary charges for medical services rendered.
  3. Attach a copy of the HCS Patient Treatment Plan Form accompanied by all relevant file notes.
  4. Attach copies of all operative reports and diagnostic test reports and mail to:
    Horizon Casualty Services, Inc.
    PO Box 10175
    Newark, NJ 07101-3175

All amounts paid for covered services are subject to applicable program limitations and exclusions, including but not limited to applicable copayments, coinsurance and deductibles (if any), as specifically provided in the applicable program or by law.

No physician or other health care professional may demand or request any payment from any person in excess of those permitted by the medical fee schedules established by New Jersey insurance law. Reimbursement of billed services may be issued by the claimant’s insurer or the third party administrator (TPA). Reimbursement of bill services for State of New Jersey claimants is issued by HCS.

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