Blue Review June 2021
Introducing the Provider Data Maintenance Tool
Having the most current and accurate information in our Doctor & Hospital Finder helps our members find you, learn about your practice and get the care they need. Our new Data Maintenance Tool makes it easy for you to change the information we display to our members:
- Update phone and fax numbers
- Add or update office email address(es)
- Manage practice limitations
- Manage areas of expertise for behavioral health services
- Indicate if you offer telemedicine services
- Provide information about your race/ethnicity
Your NaviNet Security Officer can sign in to NaviNet to access the Data Maintenance Tool through the Horizon BCBSNJ Plan Central page. If you don’t have access to NaviNet, you can sign up for free with your Federal Tax ID.
Your Patients’ Benefit Information is Only a Click Away
Returning Outstanding Credit Balances
Our Credit Balance Adjustment Request Form allows your facility to return overpayments for claim reimbursements. This form should be used for all credit balances that are outstanding for 30 or more days.
Completed copies of this form, along with copies of payment vouchers, hospital bills and other supporting documentation, may be faxed to the contact information included on the form.
Personalized Health Services to be Offered to Select Members
You may have members who are eligible to receive personalized health services and coaching — at no additional cost — through MOBE®. You will receive information from MOBE if your patients are eligible.
What’s included ?
Eligible members receive information, guidance and support to help them feel their best. Services include:
- A health coach who will work with members through one-on-one conversations by phone or through the MOBE Health Guide app.
- Guidance to improve overall quality of life by addressing sleep habits, nutrition, exercise and stress management.
- Access to pharmacists to discuss medications to optimize effectiveness.
Helping Teens Transition from Child to Adult Care
It is always a critical time when a teen transitions into adulthood. It changes their health care needs too. The American Academy of Pediatrics recommends transitioning to adult-oriented health care between the ages of 18 and 21. If you are a pediatrician providing care and treatment to patients over age 18, please evaluate their care needs and begin talking to them about transitioning care to an adult Primary Care Physician.
This may include helping them choose a new physician and transferring medical records. You also may need to assist with the transfer of specialty care to adult subspecialists.
Care Management Programs and Your Patients
Our Care Management Programs collaborate with you to help improve health care quality, enhance the patient experience and lower costs. Participation in our Care Management Programs is voluntary and at no additional cost to eligible members.
Case Management Program
Our Case Management Program provides members and their families with important resources. Case Management is suggested for members who have certain complex illnesses such as:
- Heart surgery
- High-risk pregnancy
- Newborn abnormalities
- Organ transplant
- Severe injury or paralysis
Chronic Care Program
Our Chronic Care Program can help patients who are diagnosed with one of the following conditions:
- Chronic Obstructive Pulmonary Disease
- Coronary Artery Disease
- Heart Failure
You can refer eligible members to the Chronic Care Program by:
- Completing the enrollment form; or
- Calling the Member Services phone number located on the member’s ID card.
Care Management Programs may not be available for all Horizon BCBSNJ health plans or lines of business.
Braven Health: Important Information About Submitting Claims and Receiving Reimbursement
If you participate in the Horizon Managed Care Network, you’ve probably already treated a member enrolled in one of our Braven HealthSM plans.
Braven Health is an affiliate of Horizon BCBSNJ that offers Medicare Advantage plans to beneficiaries who reside in one of eight New Jersey Counties.
Your participation in Braven Health plans is based on your current participation with existing Horizon BCBSNJ Medicare Advantage plans.
- You are in network for the new Braven Health plans based on your participation in our existing Horizon BCBSNJ Medicare Advantage plans.
- The subset used by the Braven Medicare Plus (HMO) plan is the same subset used for our existing Horizon Medicare Blue Advantage plans.
Submitting Braven Health claims and getting reimbursement
Braven Health has its own Payer ID (84367) that you should use when submitting claims. Please do not use the Horizon BCBSNJ Payer ID when submitting claims for your Braven patients.
- Providers must use this separate Payer ID (84367) for Braven Health for claims and other electronic transactions with Braven Health.
If you haven’t already registered for Braven Health EDI, please do so immediately.
Highlighting Provider Stories
Check out our recent provider stories spotlighting some of our collaborative programs and initiatives:
When Planning, Collaboration and Crisis Merge — A Medical Practice's Successful Response to COVID-19
When the COVID-19 public health emergency hit New Jersey in 2020, Vanguard Medical Group (Vanguard), a primary care practice with 10 offices in northern and central New Jersey, was in a unique position to quickly adapt and respond to the crisis.
Providing Innovative Cancer Care — Expanding Episodes of Care
When someone is diagnosed with cancer, their whole life changes. Among the first things they must do is discuss treatment options with their doctor. Even after this discussion, they may face uncertainty and confusion about the many decisions they will have to make. With cancer, there is never a one-size-fits-all approach.
Value-Based Care — Transforming Health Care with Better Collaboration and Improved Health Outcomes
Value-based models are the leaders in incentivizing providers to provide quality care, and with good reason. Unlike other reimbursement and care models, a value-based approach holds providers accountable for the costs of care as well as producing better health outcomes for their patients.