Claim Adjustments to be Performed: Clinical Laboratory Services
Based on a recent review, Horizon BCBSNJ determined that certain claims for clinical laboratory services rendered between January 1, 2019 and September 19, 2019 to patients enrolled in plans that use the Horizon Managed Care Network were denied in error with the message below.
- B685: This service is not paid. Laboratory services must be performed by a laboratory in the Preferred Network for Managed Care Products. There is no member liability for this service if performed by a participating provider.
On October 11, 2019, we corrected the issues causing these incorrect denials of clinical laboratory services included on certain claims submitted by participating and nonparticipating clinical labs as well as professional group practice locations with onsite laboratory capabilities.1
On January 6, 2020, Horizon BCBSNJ will begin adjusting impacted claims for clinical laboratory services rendered between January 1, 2019 and October 10, 2019 to ensure that they are processed appropriately according to member benefits and eligibility.
Reimbursement details, including changes to member responsibility, will be included on Explanation of Payment statement(s) and member Explanation of Benefits (EOB) statements generated following each adjustment.
We thank you in advance for promptly reimbursing your patients for any amounts that you may have previously collected from them based upon the original adjudication of these impacted claims.
We apologize for any inconvenience.
If you have questions, please call Physician Services at 1-800-624-1110, Monday through Friday, between 8 a.m. and 5 p.m., Eastern Time.
1Please note that the B685 message is appropriate for many clinical laboratory procedure codes and that not all claims denied with this message were denied in error.