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Quarterly Claim Editing Update: Fourth Quarter 2019

Horizon BCBSNJ is presently upgrading one of the primary source systems we use to carry out our quarterly claim editing updates. As a result, the implementation of certain fourth quarter (Q4) claim edit changes/updates will be delayed until January 2020. Details about this delayed implementation will be provided later this year.

Q4 claim editing updates related to rules/guidelines implemented by the Centers for Medicare & Medicaid Services (CMS) National Correct Coding Initiative (NCCI) were implemented on October 1, 2019 for patients enrolled in fully insured and Medicare Advantage plans only¹. Details of these updates may be accessed by visiting the following CMS web pages:

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

Read more about our Claim Editing Policies.

¹These Q4 NCCI claim edit updates will be implemented with the delayed Q4 claim edit changes/updates for patients enrolled in Administrative Services Only (ASO) including State Health Benefits Program (SHBP)/School Employees’ Health Benefits Program (SEHBP) plans.

Published on: November 1, 2019, 04:39 a.m. ET
Last updated on: April 28, 2021, 00:01 a.m. ET