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Pre-Admission Testing Reimbursement Policy Update

Effective February 15, 2021, Horizon BCBSNJ will change how we consider certain claims for preadmission testing services based on the updated guidelines of our Pre-Admission Testing reimbursement policy.

Per the policy guidelines, services related to a patient’s planned inpatient admission or same day surgery performed on the day of, or within the 72-hour period prior to the day of, a patient’s planned inpatient admission or same day surgery service are considered Pre-Admission Testing (PAT) services and are not considered for separate reimbursement.

Horizon BCBSNJ will expand the policy scope so that it does NOT consider PAT services for reimbursement if rendered at an entity associated, or affiliated with, the location at which the patient’s inpatient admission or same day surgery will be performed for services on and after February 15, 2021. (e.g. part of hospital system, affiliated ambulatory surgery center, etc.).

This includes, but is not limited to, COVID-19 testing for all planned inpatient admissions and same day surgery services.

The policy guidelines apply to patients enrolled in all insured commercial plans, Medicare Advantage plans and Administrative Services Only employer group plans including New Jersey State Health Benefits Program/School Employees’ Health Benefits Program (SHBP/SEHBP) plans.

Horizon BCBSNJ reserves the right to adjust claims for PAT services provided on and after February 15, 2021 that are not processed according the policy guidelines.

We encourage you to review the content of this reimbursement policy at HorizonBlue.com/medicalpolicy.

Published on: November 2, 2020, 04:20 a.m. ET
Last updated on: November 5, 2020, 05:33 a.m. ET