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Claim Adjustment Notification: Correct Coding/Code-Editing Guidelines

On October 22, 2018, Horizon Blue Cross Blue Shield of New Jersey will begin adjusting certain professional claims processed between May 2017 and March 2018 to ensure that the procedure codes submitted are processed in accordance with nationally recognized coding and code-editing guidelines. This includes guidelines implemented by the Centers for Medicare & Medicaid Services (CMS), National Correct Coding Initiative (NCCI), Outpatient Code Editor (OCE), American Medical Association (AMA), Current Procedural Terminology (CPT®), Healthcare Common Procedure Coding System (HCPCS) and the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM).

Review the list of claim-processing guidelines that will be addressed by claim adjustments to be conducted beginning October 22, 2018.

These actions are part of a larger Horizon BCBSNJ effort to ensure that claims identified during the course of recent audits are processed in accordance with nationally recognized coding and code-editing guidelines. Previous announcements related to this effort were posted to HorizonBlue.com/providernews on September 14, 2017 and January 5, 2018. Future efforts to advise of additional edits to be addressed will also be posted on HorizonBlue.com/providernews.

Reimbursement details, including any changes to member cost sharing responsibility, will be included in the Explanation of Payment statement(s) and member Explanation of Benefits statement(s) we will generate following the completion of each claim adjustment.

If you have questions, call Physician Services at 1-800-624-1110, Monday through Friday, between 8 a.m. and 5 p.m., Eastern Time.

CPT® is a registered mark of the American Medical Association.

Published on: September 21, 2018, 11:27 a.m. ET
Last updated on: September 21, 2018, 11:50 a.m. ET