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Institutional

The UB04 form must be used if you submit paper institutional claims. The UPIN number should always be present within the appropriate UB04 Box 51A, B and C. All institutional claims for Horizon BCBSNJ members should be mailed to the address on the claim form.

Invalid or Incomplete Diagnosis codes

  • CMS requires that an ICD-9 diagnosis code be submitted with the 4th or 5th digit when applicable, in order for the codes to be considered complete. Please be sure to review the most recent ICD-9 manual for current codes.
  • CMS accepts only ICD-9 codes for Inpatient claims and HCPCS/CPT-4 codes for outpatient claims in Boxes 80 and 81 on the UB 04 form.
  • Submit only valid CPT-4, HCPCS, procedure and value codes.
  • We use the most recent HINT/HIPAA guidelines. Please be sure to review your manuals for the most current codes. Ensure you are using the appropriate codes for the date when services are rendered.

Invalid Admission Hour, Type, Source and Discharge Hour

All inpatient claims require a valid admission hour, type, source and discharge hour.

Incomplete patient and insured’s information

Patient and Insured’s name must be present on the UB 04 from with the appropriate patient relationship code.

Incomplete secondary claim processing information

Please include the appropriate payer information on all secondary claim submissions.

Missing or invalid dates

Include valid dates when reporting the following codes:

  • Principal Procedure Code
  • Occurrence Code
  • Occurrence Span Code
  • Other Procedure Code