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- Reminder: Select one method for COVID-19 and Influenza TestingReminder: Select one method for COVID-19 and Influenza Testing
- Antibody testing: FDA and CDC do not recommend use to determine immunityAntibody testing: FDA and CDC do not recommend use to determine immunity
- Antibody testing: Do not use to determine immunityAntibody testing: Do not use to determine immunity
- June 2021 Updates: COVID-19 treatment cost share waiverJune 2021 Updates: COVID-19 treatment cost share waiver
- Reminder: Use correct codes when evaluating for COVID-19Reminder: Use correct codes when evaluating for COVID-19
- Policy Update: Antibody Testing ClaimsPolicy Update: Antibody Testing Claims
- Update: Members’ cost sharing waived for treatment of COVID-19 through June 2021Update: Members’ cost sharing waived for treatment of COVID-19 through June 2021
- Submitting claims for COVID-19 vaccines delivered in non-traditional medical settingsSubmitting claims for COVID-19 vaccines delivered in non-traditional medical settings
- Every shot counts – keeping your patients informed about the COVID-19 vaccinesEvery shot counts – keeping your patients informed about the COVID-19 vaccines
- For Essential Workers, COVID-19 Treatment Covered Under Workers’ Compensation BenefitsFor Essential Workers, COVID-19 Treatment Covered Under Workers’ Compensation Benefits
- Submitting Pharmacy Claims for COVID-19 VaccinationsSubmitting Pharmacy Claims for COVID-19 Vaccinations
- COVID-19 vaccine administration reimbursement at UCCsCOVID-19 vaccine administration reimbursement at UCCs
- COVID-19 vaccines will be covered at 100%COVID-19 vaccines will be covered at 100%
- Coverage for antibody infusion therapyCoverage for antibody infusion therapy
- Update: Antibody Testing ClaimsUpdate: Antibody Testing Claims
- Update: Cost-share waiver for telemedicine and COVID-19 testing extendedUpdate: Cost-share waiver for telemedicine and COVID-19 testing extended
- Behavioral Health Continuity During the COVID-19Behavioral Health Continuity During the COVID-19
- COVID-19 Frequently Asked QuestionsCOVID-19 Frequently Asked Questions
- Reminder to use specific codes when evaluating for COVID-19Reminder to use specific codes when evaluating for COVID-19
- COVID-19 Update: Telemedicine Reimbursement Policy AddendaCOVID-19 Update: Telemedicine Reimbursement Policy Addenda
- Providing Telephonic care with no costs to membersProviding Telephonic care with no costs to members
- COVID-19 Response: Eliminating Cost-Sharing for Qualified In-Network Telemedicine ServicesCOVID-19 Response: Eliminating Cost-Sharing for Qualified In-Network Telemedicine Services
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- Surgical and Implantable Device Management Program for Cardiac Surgeries Frequently Asked Questions Updated: March 25, 2021Surgical and Implantable Device Management Program for Cardiac Surgeries Frequently Asked Questions Updated: March 25, 2021
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- Allowable Practice Locations for PathologistsAllowable Practice Locations for Pathologists
- Appointment Availability Access Standards for Primary Care-Type Providers, ObGyns, Specialists and Behavioral Health ProvidersAppointment Availability Access Standards for Primary Care-Type Providers, ObGyns, Specialists and Behavioral Health Providers
- Credentialing and Recredentialing Policy for Ancillary and Managed Long Term Support Service (MLTSS) ProvidersCredentialing and Recredentialing Policy for Ancillary and Managed Long Term Support Service (MLTSS) Providers
- Credentialing and Recredentialing Policy for Participating Physicians and Healthcare ProfessionalsCredentialing and Recredentialing Policy for Participating Physicians and Healthcare Professionals
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- Material Adverse Change (MAC) Notification PolicyMaterial Adverse Change (MAC) Notification Policy
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- Outlier Audit Programs: Post Payment and Pre-PaymentOutlier Audit Programs: Post Payment and Pre-Payment
- Physician and Healthcare Professional Counseling and Termination Policy - Professional CompetencyPhysician and Healthcare Professional Counseling and Termination Policy - Professional Competency
- Participation Status in Products that Utilize Tiering and/or Subset of an Existing Horizon NetworkParticipation Status in Products that Utilize Tiering and/or Subset of an Existing Horizon Network
- Practice Location ReinstatementsPractice Location Reinstatements
- Practice Locations LimitPractice Locations Limit
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- Retainer Based MedicineRetainer Based Medicine
- SHBP/SEHBP Inpatient Readmission ReimbursementSHBP/SEHBP Inpatient Readmission Reimbursement
- Standards for All Types of Medical and Dental Diagnostic Radiology and Imaging FacilitiesStandards for All Types of Medical and Dental Diagnostic Radiology and Imaging Facilities
- Tier Awareness PolicyTier Awareness Policy
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Reimbursement Policies & GuidelinesReimbursement Policies & Guidelines
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- Add-on Payment for COVID-19 Diagnostic Testing Run on High Throughput Technology (U0005)Add-on Payment for COVID-19 Diagnostic Testing Run on High Throughput Technology (U0005)
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- Continuous Positive Airway Pressure or Bi-level Positive airway Pressure (CPAP/BiPAP) SuppliesContinuous Positive Airway Pressure or Bi-level Positive airway Pressure (CPAP/BiPAP) Supplies
- COVID 19 Antibody TestingCOVID 19 Antibody Testing
- Daily Management of Epidural or Subarachnoid Continuous Drug AdministrationDaily Management of Epidural or Subarachnoid Continuous Drug Administration
- Daily Maximum Units for Surgical Pathology and Microscopic ExaminationDaily Maximum Units for Surgical Pathology and Microscopic Examination
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- Distinct Procedural Service Modifiers (59, XE, XP, XS, XU)Distinct Procedural Service Modifiers (59, XE, XP, XS, XU)
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- Drug Wastage – Modifier JWDrug Wastage – Modifier JW
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- Enhancement to CMS Always Bundled EditEnhancement to CMS Always Bundled Edit
- Evaluation and Management Services with Chiropractic Manipulative TreatmentEvaluation and Management Services with Chiropractic Manipulative Treatment
- Evaluation and Management Services with Osteopathic Manipulative TreatmentEvaluation and Management Services with Osteopathic Manipulative Treatment
- Evaluation and Management Services billed with Global Radiology, Stress Test, Stress Echo, Myocardial Profusion ImagingEvaluation and Management Services billed with Global Radiology, Stress Test, Stress Echo, Myocardial Profusion Imaging
- False ClaimsFalse Claims
- Frequency of Care Coordination Services and ESRD ProceduresFrequency of Care Coordination Services and ESRD Procedures
- Frequency of G0179Frequency of G0179
- Hip ArthroscopyHip Arthroscopy
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- Knee ArthroscopyKnee Arthroscopy
- Lab Panel RebundlingLab Panel Rebundling
- Laboratory Services Billed by PhysiciansLaboratory Services Billed by Physicians
- Laser Treatment of Psoriasis or ParapsoriasisLaser Treatment of Psoriasis or Parapsoriasis
- Maternity ReimbursementMaternity Reimbursement
- Maximum Units for AnesthesiaMaximum Units for Anesthesia
- Medical Nutrition Therapy (MNT)Medical Nutrition Therapy (MNT)
- Microsurgery and Robotic SurgeryMicrosurgery and Robotic Surgery
- Modifier 25Modifier 25
- Modifier 50 Bilateral GuidelinesModifier 50 Bilateral Guidelines
- Modifier 52Modifier 52
- Modifier 53Modifier 53
- Modifier 54Modifier 54
- Modifier 55Modifier 55
- Modifier 56Modifier 56
- Modifier 57Modifier 57
- Modifier 76Modifier 76
- Modifier 77Modifier 77
- Modifier 78Modifier 78
- Modifier SUModifier SU
- Multiple Procedure ReductionsMultiple Procedure Reductions
- Mutually and Non-Mutually Exclusive NCCI Supplemental EditsMutually and Non-Mutually Exclusive NCCI Supplemental Edits
- Non-ESRD ESA Level ReportingNon-ESRD ESA Level Reporting
- Noncovered Related ServicesNoncovered Related Services
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Outpatient Facility Code Edits: Bundling and Revenue CodesOutpatient Facility Code Edits: Bundling and Revenue Codes
- Outpatient Facility Code Edits: Bundling and Revenue Codes
- Bundled ServicesBundled Services
- Lab codes when billed with other servicesLab codes when billed with other services
- Revenue Codes Requiring HCPCS CodesRevenue Codes Requiring HCPCS Codes
- Typically packaged codesTypically packaged codes
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- Outpatient Laboratory Claims: Referring Practitioner RequiredOutpatient Laboratory Claims: Referring Practitioner Required
- Outpatient Therapy Daily MaximumOutpatient Therapy Daily Maximum
- Physician Extenders Non-Surgical ServicesPhysician Extenders Non-Surgical Services
- Pre-Admission TestingPre-Admission Testing
- Pre-Payment Documentation Requests: Facility ClaimsPre-Payment Documentation Requests: Facility Claims
- Post Payment Documentation Requests: Facility ClaimsPost Payment Documentation Requests: Facility Claims
- Pulmonary Diagnostic Procedures when billed with E&M CodesPulmonary Diagnostic Procedures when billed with E&M Codes
- Radiology, Preliminary and Double ReadsRadiology, Preliminary and Double Reads
- RadiopharmaceuticalsRadiopharmaceuticals
- Reimbursement and Billing Guidelines for Anesthesia ClaimsReimbursement and Billing Guidelines for Anesthesia Claims
- Removal of Impacted Cerumen Requiring InstrumentationRemoval of Impacted Cerumen Requiring Instrumentation
- Screening and Diagnostic Mammography & 3D TomosynthesisScreening and Diagnostic Mammography & 3D Tomosynthesis
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- Telemedicine Services Reimbursement Policy: Temporary Addendum for Horizon BCBSNJ Commercial/ASO plans and productsTelemedicine Services Reimbursement Policy: Temporary Addendum for Horizon BCBSNJ Commercial/ASO plans and products
- Telemedicine Services Reimbursement Policy: Temporary Addendum for Horizon Medicare AdvantageTelemedicine Services Reimbursement Policy: Temporary Addendum for Horizon Medicare Advantage
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- Ulcer Debridement and Ulcer StagesUlcer Debridement and Ulcer Stages
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Utilization ManagementUtilization Management
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Services Requiring Prior AuthorizationServices Requiring Prior Authorization
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ResourcesResources
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Consumer Assessment of Healthcare Providers and Systems (CAHPS)Consumer Assessment of Healthcare Providers and Systems (CAHPS)
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Participating Physician and Other Health Care Professional Office ManualParticipating Physician and Other Health Care Professional Office Manual
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