Update: Timeliness of Claim Adjustments

Based on the Health Claims Authorization, Processing and Payment Act (HCAPPA) for fully insured claims, Horizon BCBSNJ does not seek reimbursement for overpayment of a claim previously paid later than 18 months after the date the first payment was made*

Effective September 18, 2020, Horizon BCBSNJ will not adjust fully insured claims to provide additional reimbursement for a claim later than 18 months from the date the first payment on the claim was made (or the date the claim was first finalized if no payment was made).

Horizon BCBSNJ is aligning our approach to claim adjustments that result in the generation of additional payment with established HCAPPA timeliness and responsiveness standards pertaining to claim payment recoveries.

This change will not apply to claims currently going through the appeal process or to claims that are part of a continual claim submission.

*Per HCAPPA, limited exceptions apply