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COVID-19 Information
COVID-19 Information
COVID-19 Information
Policy Update: Antibody Testing Claims
Policy Update: Antibody Testing Claims
Update: Members’ cost sharing waived for treatment of COVID-19 through June 2021
Update: Members’ cost sharing waived for treatment of COVID-19 through June 2021
Submitting claims for COVID-19 vaccines delivered in non-traditional medical settings
Submitting claims for COVID-19 vaccines delivered in non-traditional medical settings
Every shot counts – keeping your patients informed about the COVID-19 vaccines
Every shot counts – keeping your patients informed about the COVID-19 vaccines
For Essential Workers, COVID-19 Treatment Covered Under Workers’ Compensation Benefits
For Essential Workers, COVID-19 Treatment Covered Under Workers’ Compensation Benefits
Submitting Pharmacy Claims for COVID-19 Vaccinations
Submitting Pharmacy Claims for COVID-19 Vaccinations
Update: Prior Authorization Requirements for Inpatient Admissions and Post-Acute Facility Admissions to be Reinstated
Update: Prior Authorization Requirements for Inpatient Admissions and Post-Acute Facility Admissions to be Reinstated
COVID-19 vaccine administration reimbursement at UCCs
COVID-19 vaccine administration reimbursement at UCCs
COVID-19 vaccines available in Essex County – Information for your staff and patients
COVID-19 vaccines available in Essex County – Information for your staff and patients
Reimbursement Policy effective January 1, 2021: Add-on Payment for COVID-19 Diagnostic Testing Run on High Throughput Technology (U0005)
Reimbursement Policy effective January 1, 2021: Add-on Payment for COVID-19 Diagnostic Testing Run on High Throughput Technology (U0005)
COVID-19 vaccines will be covered at 100%
COVID-19 vaccines will be covered at 100%
Coverage for antibody infusion therapy
Coverage for antibody infusion therapy
Waiving Prior Authorization Requirements for Emergent In-Network Inpatient Admissions and Post-Acute Facility Admissions
Waiving Prior Authorization Requirements for Emergent In-Network Inpatient Admissions and Post-Acute Facility Admissions
Update: Antibody Testing Claims
Update: Antibody Testing Claims
Update: Cost-share waiver for telemedicine and COVID-19 testing extended
Update: Cost-share waiver for telemedicine and COVID-19 testing extended
Cost Sharing on Claims with Multiple Diagnoses
Cost Sharing on Claims with Multiple Diagnoses
Dates for Certain Prior Authorization Waivers Further Extended
Dates for Certain Prior Authorization Waivers Further Extended
Dates for Prior Authorization Waivers Extended
Dates for Prior Authorization Waivers Extended
New Laboratory COVID-19 Antibody Testing Codes: 86328 and 86769
New Laboratory COVID-19 Antibody Testing Codes: 86328 and 86769
Help for health care professionals
Help for health care professionals
COVID-19 Update: Medical Policy Revisions & Implementations
COVID-19 Update: Medical Policy Revisions & Implementations
72 Doctors, Nurses, Pharmacists and Health Clinicians from Horizon BCBSNJ Answer Governor Murphy’s “HealthCare Professionals Call to Serve”
72 Doctors, Nurses, Pharmacists and Health Clinicians from Horizon BCBSNJ Answer Governor Murphy’s “HealthCare Professionals Call to Serve”
New Jersey Pandemic Relief Fund Efforts Get $2 Million Boost from Horizon
New Jersey Pandemic Relief Fund Efforts Get $2 Million Boost from Horizon
A special message from Howard A. Cutler, Vice President, Healthcare Delivery
A special message from Howard A. Cutler, Vice President, Healthcare Delivery
Behavioral Health Continuity During the COVID-19 Public Health Emergency
Behavioral Health Continuity During the COVID-19 Public Health Emergency
COVID-19 Frequently Asked Questions
COVID-19 Frequently Asked Questions
Waiving Pre-Certification/Prior Authorization requirements for Physical Health Post-Acute Facility Admissions
Waiving Pre-Certification/Prior Authorization requirements for Physical Health Post-Acute Facility Admissions
Horizon BCBSNJ Commits $2.5 Million for Masks, Face Shields, Food and Social Services to Protect Our Communities and Our Health Professionals
Horizon BCBSNJ Commits $2.5 Million for Masks, Face Shields, Food and Social Services to Protect Our Communities and Our Health Professionals
COVID-19 Update: Authorizations Waived for Oxygen Following ER Discharge
COVID-19 Update: Authorizations Waived for Oxygen Following ER Discharge
Reminder to use specific codes when evaluating for COVID-19
Reminder to use specific codes when evaluating for COVID-19
COVID-19 Update: Telemedicine Reimbursement Policy Addenda
COVID-19 Update: Telemedicine Reimbursement Policy Addenda
Provisionally Join Horizon BCBSNJ Network(s) to Assist with the COVID-19 Pandemic
Provisionally Join Horizon BCBSNJ Network(s) to Assist with the COVID-19 Pandemic
Waiving Pre-Certification/Prior Authorization requirements for acute inpatient facility admissions
Waiving Pre-Certification/Prior Authorization requirements for acute inpatient facility admissions
Providing Telephonic care with no costs to members
Providing Telephonic care with no costs to members
COVID-19 Response: Eliminating Cost-Sharing for Qualified In-Network Telemedicine Services
COVID-19 Response: Eliminating Cost-Sharing for Qualified In-Network Telemedicine Services
COVID-19 CPT testing codes
COVID-19 CPT testing codes
Eliminating Cost Sharing Related to COVID-19 Testing and Evaluation
Eliminating Cost Sharing Related to COVID-19 Testing and Evaluation
Staying Informed: COVID-19 Coronavirus
Staying Informed: COVID-19 Coronavirus
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Surgical and Implantable Device Management Program for Cardiac Surgeries Frequently Asked Questions Updated: March 25, 2021
Surgical and Implantable Device Management Program for Cardiac Surgeries Frequently Asked Questions Updated: March 25, 2021
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Safety and Quality Award Program Q&A
Surgical and Implantable Device Management Program Orthopedic Services Frequently Asked Questions Updated: March 25, 2021
Surgical and Implantable Device Management Program Orthopedic Services Frequently Asked Questions Updated: March 25, 2021
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Appointment Availability Access Standards for Primary Care-Type Providers, ObGyns, Specialists and Behavioral Health Providers
Credentialing and Recredentialing Policy for Ancillary and Managed Long Term Support Service (MLTSS) Providers
Credentialing and Recredentialing Policy for Ancillary and Managed Long Term Support Service (MLTSS) Providers
Credentialing and Recredentialing Policy for Participating Physicians and Healthcare Professionals
Credentialing and Recredentialing Policy for Participating Physicians and Healthcare Professionals
EDI and NaviNet Claims Submission Requirement
EDI and NaviNet Claims Submission Requirement
Electronic Funds Transfer (EFT)
Electronic Funds Transfer (EFT)
Material Adverse Change (MAC) Notification Policy
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Out-of-Network Referral Policy
Outlier Audit Programs: Post Payment and Pre-Payment
Outlier Audit Programs: Post Payment and Pre-Payment
Physician and Healthcare Professional Counseling and Termination Policy - Professional Competency
Physician and Healthcare Professional Counseling and Termination Policy - Professional Competency
Participation Status in Products that Utilize Tiering and/or Subset of an Existing Horizon Network
Participation Status in Products that Utilize Tiering and/or Subset of an Existing Horizon Network
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Practice Location Reinstatements
Practice Locations Limit
Practice Locations Limit
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Practitioner Office Site Quality and Medical Record Keeping Standards
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Provider Directory Management
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Provider Outlier Program Frequently Asked Questions
Retainer Based Medicine
Retainer Based Medicine
Standards for All Types of Medical and Dental Diagnostic Radiology and Imaging Facilities
Standards for All Types of Medical and Dental Diagnostic Radiology and Imaging Facilities
Tier Awareness Policy
Tier Awareness Policy
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Use of Horizon Hospital Network Performance Data
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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)
After-hours and Weekend Care
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ASC Multiple Procedure Methodology
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Bariatric Surgery Billed With Hiatal Hernia Repair
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ClaimsXten Editing Rules
ClaimsXten Editing Rules
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Co-Surgeon Reimbursement
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Colonoscopy with Modifier 59
Colonoscopy with Modifier 59
Conscious Sedation
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Consumable Medical Supplies
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Continuous Positive Airway Pressure or Bi-level Positive airway Pressure (CPAP/BiPAP) Supplies
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Daily Management of Epidural or Subarachnoid Continuous Drug Administration
Daily Management of Epidural or Subarachnoid Continuous Drug Administration
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Daily Maximum Units for Surgical Pathology and Microscopic Examination
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Determination of Refractive State
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Distinct Procedural Service Modifiers (59, XE, XP, XS, XU)
Distinct Procedural Service Modifiers (59, XE, XP, XS, XU)
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Duplex Scanning
Drug Wastage – Modifier JW
Drug Wastage – Modifier JW
Duplicate Claim Logic for Independent Laboratory Services
Duplicate Claim Logic for Independent Laboratory Services
Enhancement to CMS Always Bundled Edit
Enhancement to CMS Always Bundled Edit
Evaluation and Management Services with Chiropractic Manipulative Treatment
Evaluation and Management Services with Chiropractic Manipulative Treatment
Evaluation and Management Services with Osteopathic Manipulative Treatment
Evaluation and Management Services with Osteopathic Manipulative Treatment
Evaluation and Management Services billed with Global Radiology, Stress Test, Stress Echo, Myocardial Profusion Imaging
Evaluation and Management Services billed with Global Radiology, Stress Test, Stress Echo, Myocardial Profusion Imaging
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Frequency of Care Coordination Services and ESRD Procedures
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Maximum Units for Anesthesia
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Medical Nutrition Therapy (MNT)
Medical Nutrition Therapy (MNT)
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Modifier 25
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Pre-Payment Documentation Requests: Facility Claims
Post Payment Documentation Requests: Facility Claims
Post Payment Documentation Requests: Facility Claims
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Pulmonary Diagnostic Procedures when billed with E&M Codes
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Radiology, Preliminary and Double Reads
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Removal of Impacted Cerumen Requiring Instrumentation
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Telemedicine Services Reimbursement Policy: Temporary Addendum for Horizon BCBSNJ Commercial/ASO plans and products
Telemedicine Services Reimbursement Policy: Temporary Addendum for Horizon BCBSNJ Commercial/ASO plans and products
Telemedicine Services Reimbursement Policy: Temporary Addendum for Horizon Medicare Advantage
Telemedicine Services Reimbursement Policy: Temporary Addendum for Horizon Medicare Advantage
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PT/OT Outpatient Prior Authorization for Horizon Medicare Advantage Plans
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Prior Authorization Procedure Search Tool
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Dates for Prior Authorization Waivers Extended
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72 Doctors, Nurses, Pharmacists and Health Clinicians from Horizon BCBSNJ Answer Governor Murphy’s “HealthCare Professionals Call to Serve”
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Periodontal Specialty Referral Authorization
horizon-bcbsnj-periodontal-spec-ref-auth-1649.pdf