Professional

Claims are a vital link between your office and Horizon BCBSNJ. Generally, claims must be submitted within 180 days of the date of service.

Electronic Submissions

We require all physicians and other health care professionals to submit claims to us electronically. Horizon BCBSNJ’s electronic payor ID is 22099.

Our e-Service Desk’s EDI team is available to discuss your electronic claim submission options or enhancing your current practice management system with specifications for electronic submission to us. For more information on submitting your claims electronically, contact the e-Service Desk’s EDI team at 1-888-334-9242, via email at HorizonEDI@HorizonBlue.com or by fax at 1-973-274-4353.

Helpful Hints for Claims Submissions

To assist us with the expeditious and accurate processing of your claims:

• Ask for the patient’s ID card at each visit to have the most current enrollment information available. Always photocopy both sides of the ID card for your files.
• Don’t confuse the subscriber with your patient. The patient is always the person you treat. Complete the patient information on your claim as it relates to the person being treated.
• Use the subscriber’s and/or patient’s full name. Avoid nicknames or initials.
• Complete the patient’s date of birth.
• Claims must include the entire ID number. Always use the prefixes or suffixes that surround the ID number. For Federal Employee Program® (FEP®) claim submissions, please disregard any characters after the eighth numeric character following the R prefix.
• Complete the group number field on the claim form when it appears on the ID card.
• When you treat a patient due to an injury, be sure to include the date the injury occurred.
• When appropriate, be sure to include the date of onset for the illness you are treating.
• Always include rendering, referring and admitting physician NPI information as appropriate on claim submissions.
• When submitting claims under your NPI, please remember that your tax ID number is also required.
• Clearly itemize your charges and date(s) of service.
• Use accurate and specific ICD diagnosis codes for each condition you are treating. List the primary diagnosis first. To report multiple ICD-10 codes (our systems can handle up to four), list each one with the corresponding procedure by numbers 1, 2 or 3.
• Always use accurate five-digit CPT-4 or HCPC codes.
• Please use valid, compliant codes for the date on which services were rendered.
• When the patient’s primary insurance is traditional Medicare, claims are sent to Horizon BCBSNJ from CMS national crossover contractor, the Benefits Coordination & Recovery Center (BCRC). Claims are transmitted after the Medicare Payment Floor (14 days) is reached, regardless of when you receive a remittance advice. If you do not receive a payment summary from us, submit the claim 30 days after you receive the Medicare Remittance along with a copy of the Medicare Provider Summary.
• If the patient has any other insurance, please record the patient’s Coordination of Benefits (COB) information on the claim form.
• Avoid duplicate claim submissions. Prior to resubmitting claims, please check for claim status online at NaviNet.net or call 1-800-624-1110.

Helpful Hints for Paper Claims Submissions

If you submit paper claims, your claim submissions may be processed through Optical Character Recognition (OCR). Our enhanced OCR processing provides faster and more efficient adjudication and reimbursement than the traditional methods of manually processed paper claims. The efficiency of processing paper claims through OCR depends on your legible, compliant and complete claim submission. Claims incomplete and/or illegible in these areas may be delayed.

To maximize the benefits of OCR, we recommend the following when submitting your CMS 1500 form:

• Always use an original CMS 1500 form for hard copy claim submissions. The 1500 logo on the top left of this form helps expedite claim processing.
• Make sure the print on your CMS 1500 form is clear and dark, and that characters are centered in each box.
• All characters on the CMS 1500 form need to be intact. We use OCR equipment that recognizes full characters only. If the characters are missing tops or bottoms of the letters, the OCR equipment will not function properly, causing claims processing delays. Use a laser printer for best results.
• Do not highlight or circle information or apply extraneous stamps or verbiage to the forms. Highlighting, circling and stamps may prevent our scanners from correctly identifying characters.
• Include rendering, referring and admitting physician NPI information on all appropriate claim submissions.
• For information omitted from computer-prepared forms, use typewritten instead of handwritten data.
• Do not staple any submitted documents.

Claim Submission Instructions - Institutional

Claims Submission

Claims are a vital link between your hospital and Horizon BCBSNJ. Please submit them in a timely manner.

Electronic Submissions

Electronic claims submissions help speed our reimbursement to you. We encourage all hospitals to submit claims to us electronically.

Our eService Help Desk’s Electronic Data Interchange (EDI) team is available to discuss your electronic claim submission options or enhancing your current practice management system with specifications for electronic submission to us. For more information on submitting your claims electronically, contact the eService Help Desk’s EDI team toll-free at 1-888-334-9242, via email at HorizonEDI@HorizonBlue.com or by fax at 1-973-274-4353.

Helpful Hints for Claims Submissions

• Ask for the patient’s current ID card during the inpatient or outpatient admission process. Always photocopy both sides of the ID card for your files.
• Use the subscriber’s and/or patient’s full name. Avoid nicknames or initials.
• Date(s) of birth for the subscriber and the patient, if different, are important.
• If the patient has any other insurance coverage, be sure that we have complete information when you submit your claim. If another carrier is primary and incomplete information is received, it will result in a delay or denial of payment.
• Complete the patient information on your claim as it relates to the person being treated. The patient may or may not be the subscriber.
• Claims must include the entire ID number. Always use the prefixes associated with the ID number.
• Complete the group number field when that information appears on the ID card.
• Clearly itemize services provided, your charges and date(s) of service.
• When you treat a patient due to an injury, be sure to include the date the injury occurred.
• When appropriate, be sure to include the date of the onset of illness.
• Provide the referral or authorization number, as applicable.
• Always use the most current codes as identified in the UB-04 Data Elements Specifications Manual as developed by the National Uniform Committee of the American Hospital Association.
• Ensure claim submissions have the correct revenue codes and charges for services rendered.
• Ensure that inpatient claims include a valid admission hour, type, source and discharge hour.
• Ensure that valid dates are included when reporting Principal Procedure Code, Occurrence Code, Occurrence Span Code and Other Procedure Code.
• Be sure to supply the name, address and National Provider Identifier (NPI) of your hospital.
• Prior to submitting the claim for reimbursement, verify that all listed services were provided.
• Be sure to correct errors in your claim submission reports in a timely manner prior to resubmission.
• To avoid adjustments for late charges, ensure that submitted bills reflect all services rendered to the patient during a given hospital stay.
• When treating patients with out-of-state Blue Cross and/or Blue Shield Plan coverage, submit your claim to Horizon BCBSNJ. We will forward claims information to the other Plan on your behalf.
• With every Coordination of Benefits (COB) claim, send a completed UB-04. When Horizon BCBSNJ is secondary, also provide information on how the primary carrier processed the claim.
• When the patient’s primary insurance is original Medicare, claims are sent to Horizon BCBSNJ from CMS national crossover contractor, the Benefits Coordination & Recovery Center (BCRC). Claims are transmitted after the Medicare Payment Floor (14 days) is reached, regardless of when you receive a remittance advice.

If you do not receive a payment summary from us, submit the claim 30 days after you receive the Medicare Remittance along with a copy of the Medicare Provider Summary.

Helpful Hints for Paper Claims Submissions

If you submit paper claims, your claim submissions may be processed through Optical Character Recognition (OCR). Our enhanced OCR processing provides faster and more efficient adjudication and reimbursement than manually processing paper claims. However, the efficiency of processing paper claims through OCR depends on your legible, compliant and complete claim submission.

To maximize the benefits of OCR, we recommend the following when submitting your UB-04 form:

• All paper claim submissions must be on an original, government-approved, red-lined UB-04 claim form. Claim submissions that we receive on photocopies of the UB-04 claim form or on another carrier’s claim submission forms will not be processed.
• Always fill out UB-04 forms completely and accurately. Pay close attention to required fields to minimize processing delays.
• Use dark ink (black ink is recommended).
• All characters on the UB-04 form need to be intact. We use OCR equipment that recognizes full characters only. If the characters are missing tops or bottoms of the letters, the OCR equipment will not function properly, causing claim processing delays. Use a laser printer for best results.
• Center characters in each box on the UB-04 form.
• Use a standard Sans Serif font and select a font size that fits comfortably within the boxes.
• Do not apply extraneous stamps or verbiage to the forms.
• Do not circle or highlight information, as it may cover other data and cause it to become illegible.
• For information omitted from computer prepared forms, use typewritten instead of handwritten data.
• When submitting a claim for secondary carrier payment, please ensure the primary carrier’s corresponding Explanation of Benefits (EOB) is included with the UB-04 claim form (patient name, procedures and dates of service must coincide).
• Do not staple any submitted documents.

Mail paper claims to the appropriate address as noted below.

BlueCard® claims:
Horizon BCBSNJ BlueCard Claims
PO Box 1301
Neptune, NJ 07754-1301

Federal Employee Plan (FEP) claims (Plan ID numbers begin with a single R):
Horizon BCBSNJ
PO Box 656
Newark, NJ 07101-0656

For all other claims:

Medical claims:
Horizon BCBSNJ
PO Box 25
Newark NJ 07101-0025

Behavioral Health (including mental health and substance use disorder) claims:
Horizon BCBSNJ
Horizon Behavioral Health
PO Box 10191
Newark, NJ 07101-3189