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Quarterly Claim Editing Update: First Quarter 2020

On or about January 31, 2020, Horizon BCBSNJ will implement an update to our claim editing rules and processes. We encourage you to review details of this update in our Quarterly Claim Editing Update Report

  • The changes noted in this report will be implemented on or about January 31, 2020.

    The effective date of the changes noted in this report will be January 1, 2020 (unless otherwise specified in the report). Changes noted in this report will apply to all claims finalized on and after our implementation date.¹

Read more about our Claim Editing Policies.

If you have questions, call a Physician Services representative at 1-800-624-1110 or an Institutional Services representative at 1-888-666-2535, Monday through Friday, between 8 a.m. and 5 p.m., Eastern Time.

¹Claims finalized before this update is implemented will not be adjusted following the implementation for the sole purpose of ensuring conformity with these claim editing rules. If a claim originally finalized before the implementation is adjusted after the implementation for other reasons, the claim editing rules noted here will be applied.

Clear Claim Connection™
Participating physicians, other health care professionals and facilities can review how updated claim editing rules impact reimbursement for certain code combinations by using the Clear Claim Connection available via NaviNet®.

To access Clear Claim Connection, log in to NaviNet.net and:

  • Select Horizon BCBSNJ from the My Health Plans menu.
  • Mouse over Claim Management.
  • Click Clear Claim Connection.

NaviNet® is a registered trademark of NaviNet, Inc.

Published on: January 23, 2020, 01:15 a.m. ET
Last updated on: January 23, 2020, 05:00 a.m. ET