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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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- Distinct Procedural Service Modifiers (59, XE, XP, XS, XU)Distinct Procedural Service Modifiers (59, XE, XP, XS, XU)
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- Drug Wastage – Modifier JWDrug Wastage – Modifier JW
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- Evaluation and Management Services with Chiropractic Manipulative TreatmentEvaluation and Management Services with Chiropractic Manipulative Treatment
- 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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- 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
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- 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
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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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ResourcesResources
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Consumer Assessment of Healthcare Providers and Systems (CAHPS)Consumer Assessment of Healthcare Providers and Systems (CAHPS)
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HEDIS GuidelinesHEDIS Guidelines
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- Adults’ Access to Preventive/ Ambulatory Health Services (AAP)Adults’ Access to Preventive/ Ambulatory Health Services (AAP)
- Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis (AAB)Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis (AAB)
- Breast Cancer Screening (BCS)Breast Cancer Screening (BCS)
- Colorectal Cancer Screening (COL)Colorectal Cancer Screening (COL)
- Diabetes CareDiabetes Care
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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 Dependence Treatment (IET)Initiation and Engagement of Substance Use Disorder Dependence 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)
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HEDIS Measurement Year (MY) 2022 Provider Tips for Optimizing HEDIS ResultsHEDIS Measurement Year (MY) 2022 Provider Tips for Optimizing HEDIS Results
- HEDIS Measurement Year (MY) 2022 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)
- Adults’ Access to Preventive/Ambulatory Health Services (AAP)Adults’ Access to Preventive/Ambulatory Health Services (AAP)
- Advanced Care Planning (ACP)Advanced Care Planning (ACP)
- Antibiotic Utilization for Respiratory Conditions (AXR)Antibiotic Utilization for Respiratory Conditions (AXR)
- Antidepressant Medication Management (AMM)Antidepressant Medication Management (AMM)
- Appropriate Testing for Children with Pharyngitis (CWP)Appropriate Testing for Children with Pharyngitis (CWP)
- Appropriate Treatment for Upper Respiratory Infection (URI)Appropriate Treatment for Upper Respiratory Infection (URI)
- Asthma Medication Ratio (AMR)Asthma Medication Ratio (AMR)
- Avoidance of Antibiotic Treatment for Acute Bronchitis/ Bronchiolitis (AAB)Avoidance of Antibiotic Treatment for Acute Bronchitis/ Bronchiolitis (AAB)
- Blood Pressure Control for Patients With Diabetes (BPD)Blood Pressure Control for Patients With Diabetes (BPD)
- Breast Cancer Screening (BCS)Breast Cancer Screening (BCS)
- Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia (SMC)Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia (SMC)
- Care for Older Adults (COA)Care for Older Adults (COA)
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