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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)
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- Daily Management of Epidural or Subarachnoid Continuous Drug AdministrationDaily Management of Epidural or Subarachnoid Continuous Drug Administration
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- Evaluation and Management Services with Osteopathic Manipulative TreatmentEvaluation and Management Services with Osteopathic Manipulative Treatment
- Evaluation and Management Services billed with Global Radiology, Stress Test, Stress Echo, Myocardial Profusion ImagingEvaluation and Management Services billed with Global Radiology, Stress Test, Stress Echo, Myocardial Profusion Imaging
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- Horizon Fee Schedule Updates based on Third Party SourcesHorizon Fee Schedule Updates based on Third Party Sources
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- Microsurgery and Robotic SurgeryMicrosurgery and Robotic Surgery
- Modifier 25Modifier 25
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- Modifier 53Modifier 53
- Modifier 54Modifier 54
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- Modifier 56Modifier 56
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- Multiple Procedure ReductionsMultiple Procedure Reductions
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Outpatient Facility Code Edits: Bundling and Revenue CodesOutpatient Facility Code Edits: Bundling and Revenue Codes
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- Outpatient Laboratory Claims: Referring Practitioner RequiredOutpatient Laboratory Claims: Referring Practitioner Required
- Outpatient Services Prior to Admission or Same-Day SurgeryOutpatient Services Prior to Admission or Same-Day Surgery
- Outpatient Therapy Daily MaximumOutpatient Therapy Daily Maximum
- Physician Extenders Non-Surgical ServicesPhysician Extenders Non-Surgical Services
- Pre-Payment Coding Reviews Documentation RequestsPre-Payment Coding Reviews Documentation Requests
- Pre-Payment Documentation Requests: Facility ClaimsPre-Payment Documentation Requests: Facility Claims
- Post Payment Documentation Requests: Facility ClaimsPost Payment Documentation Requests: Facility Claims
- Pulmonary Diagnostic Procedures when billed with E&M CodesPulmonary Diagnostic Procedures when billed with E&M Codes
- Radiology, Preliminary and Double ReadsRadiology, Preliminary and Double Reads
- RadiopharmaceuticalsRadiopharmaceuticals
- Reimbursement and Billing Guidelines for Anesthesia ClaimsReimbursement and Billing Guidelines for Anesthesia Claims
- Removal of Impacted Cerumen Requiring InstrumentationRemoval of Impacted Cerumen Requiring Instrumentation
- Screening and Diagnostic Mammography & 3D TomosynthesisScreening and Diagnostic Mammography & 3D Tomosynthesis
- Site of Service DifferentialSite of Service Differential
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Telemedicine ServicesTelemedicine Services
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- Telemedicine Services Reimbursement Policy: Temporary Addendum for Horizon BCBSNJ Commercial/ASO plans and productsTelemedicine Services Reimbursement Policy: Temporary Addendum for Horizon BCBSNJ Commercial/ASO plans and products
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- Ulcer Debridement and Ulcer StagesUlcer Debridement and Ulcer Stages
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Utilization ManagementUtilization Management
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- Utilization Management Request ToolUtilization Management Request Tool
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ResourcesResources
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Consumer Assessment of Healthcare Providers and Systems (CAHPS)Consumer Assessment of Healthcare Providers and Systems (CAHPS)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS)
- Focusing on Your Horizon and Braven Health Patients’ Experience: Tools to Help YouFocusing on Your Horizon and Braven Health Patients’ Experience: Tools to Help You
- Discussion Checklist for CAHPS and HOS SurveysDiscussion Checklist for CAHPS and HOS Surveys
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- Cultural CompetencyCultural Competency
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HEDIS ResourcesHEDIS Resources
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HEDIS Measure Guidelines for Behavioral Health ProvidersHEDIS Measure Guidelines for Behavioral Health Providers
- HEDIS Measure Guidelines for Behavioral Health Providers
- Follow-Up Care for Children Prescribed ADHD Medication (ADD)Follow-Up Care for Children Prescribed ADHD Medication (ADD)
- Antidepressant Medication Management (AMM)Antidepressant Medication Management (AMM)
- Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM)Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM)
- Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (APP)Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (APP)
- Follow-Up After Emergency Department Visit for Substance Use (FUA)Follow-Up After Emergency Department Visit for Substance Use (FUA)
- Follow-Up After Hospitalization for Mental Illness (FUH)Follow-Up After Hospitalization for Mental Illness (FUH)
- Follow-Up After High-Intensity Care for Substance Use Disorder (FUI)Follow-Up After High-Intensity Care for Substance Use Disorder (FUI)
- Follow-Up After Emergency Department Visit for Mental Illness (FUM)Follow-Up After Emergency Department Visit for Mental Illness (FUM)
- Initiation and Engagement of Substance Use Disorder Treatment (IET)Initiation and Engagement of Substance Use Disorder Treatment (IET)
- Adherence to Antipsychotic Medications for Individuals with Schizophrenia (SAA)Adherence to Antipsychotic Medications for Individuals with Schizophrenia (SAA)
- Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications (SSD)Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications (SSD)
- Cardiovascular Monitoring for People with Cardiovascular Disease and Schizophrenia (SMC)Cardiovascular Monitoring for People with Cardiovascular Disease and Schizophrenia (SMC)
- Diabetes Monitoring for People with Diabetes and Schizophrenia (SMD)Diabetes Monitoring for People with Diabetes and Schizophrenia (SMD)
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HEDIS Measurement Year (MY) 2023 Provider Tips for Optimizing HEDIS ResultsHEDIS Measurement Year (MY) 2023 Provider Tips for Optimizing HEDIS Results
- HEDIS Measurement Year (MY) 2023 Provider Tips for Optimizing HEDIS Results
- Best Practices Overall for CodingBest Practices Overall for Coding
- Adherence to Antipsychotic Medications for Individuals With Schizophrenia (SAA)Adherence to Antipsychotic Medications for Individuals With Schizophrenia (SAA)
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- As Mental Health Needs Continue To Rise, So Do Innovative Virtual ServicesAs Mental Health Needs Continue To Rise, So Do Innovative Virtual Services
- Treat Knee, Back, and Hip Pain with Orthotic Device that Helps Avoid Invasive ProceduresTreat Knee, Back, and Hip Pain with Orthotic Device that Helps Avoid Invasive Procedures
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- How a value-based primary care provider helps the New Jersey Vaccination ProgramHow a value-based primary care provider helps the New Jersey Vaccination Program
- Improving Health Equity through Increased Access to Prenatal Care Across New JerseyImproving Health Equity through Increased Access to Prenatal Care Across New Jersey
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- Providing Innovative Cancer Care - Expanding Episodes of CareProviding Innovative Cancer Care - Expanding Episodes of Care
- Telehealth after COVID-19 – Many doctors agree it's here to stayTelehealth after COVID-19 – Many doctors agree it's here to stay
- Value-based care -- transforming health care with better collaboration and improved health outcomesValue-based care -- transforming health care with better collaboration and improved health outcomes
- When planning, collaboration and crisis merge - a medical practice's successful response to COVID-19When planning, collaboration and crisis merge - a medical practice's successful response to COVID-19
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