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Second Quarter 2021 Claim Editing Update is Delayed

In a recently posted news item, we advised that we would be implementing certain quarterly claim editing updates on or about May 21, 2021.

Due to a technical issue, these Q2 2021 claim editing updates will not be implemented until on or about June 11, 2021.

  • The effective date of these claim editing updates is for dates of services on and after April 1, 2021 (unless otherwise specified in the Quarterly Claim Editing Update Report posted with the original announcement). These updates will apply to all claims finalized on and after June 11, 2021.

  • Claims already finalized before this quarterly update is implemented will not be adjusted. However, the updated claim editing rules will be applied if a claim that was finalized before June 11, 2021 is adjusted after this implementation for other reasons.

If you have questions, please call Provider Services at 1-800-624-1110 or Institutional Services at 1-888-666-2535, weekdays, between 8 a.m. and 5 p.m., Eastern Time.

Clear Claim Connection™

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

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

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

Clear Claim Connection™ and NaviNet® are registered trademarks of NaviNet, Inc.

Published on: May 24, 2021, 12:32 p.m. ET
Last updated on: May 18, 2021, 16:08 p.m. ET