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- June 2021 Updates: COVID-19 treatment cost share waiverJune 2021 Updates: COVID-19 treatment cost share waiver
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- For Essential Workers, COVID-19 Treatment Covered Under Workers’ Compensation BenefitsFor Essential Workers, COVID-19 Treatment Covered Under Workers’ Compensation Benefits
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- 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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- 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
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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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Utilization ManagementUtilization Management
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HEDIS GuidelinesHEDIS Guidelines
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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)
- Cervical Cancer Screening (CCS)Cervical Cancer Screening (CCS)
- Child and Adolescent Well-Care Visits (WCV)Child and Adolescent Well-Care Visits (WCV)
- Childhood Immunization Status (CIS)Childhood Immunization Status (CIS)
- Chlamydia Screening in Women (CHL)Chlamydia Screening in Women (CHL)
- Colorectal Cancer Screening (COL)Colorectal Cancer Screening (COL)
- Controlling High Blood Pressure (CBP)Controlling High Blood Pressure (CBP)
- Deprescribing of Benzodiazepines in Older Adults (DBO)Deprescribing of Benzodiazepines in Older Adults (DBO)
- Diabetes Monitoring for People With Diabetes and Schizophrenia (SMD)Diabetes Monitoring for People With Diabetes and Schizophrenia (SMD)
- 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)
- Eye Exam for Patients With Diabetes (EED)Eye Exam for Patients With Diabetes (EED)
- Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence (FUA)Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence (FUA)
- Follow-Up After Emergency Department Visit for Mental Illness (FUM)Follow-Up After Emergency Department Visit for Mental Illness (FUM)
- Follow-Up After High- Intensity Care for Substance Use Disorder (FUI)Follow-Up After High- Intensity Care for Substance Use Disorder (FUI)
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