Tips for Electronic Claim Submission

Medicare Secondary Coordination of Benefit (COB) claims
Unless specifically requested, do not send Medicare COB claims to us. We receive the claims and relevant information electronically via the Medicare Crossover process provided we have been advised that Medicare is the member’s primary insurance. You can submit Medigap or Medicare Advantage claims to us where Horizon BCBSNJ is the primary insurance.

Secondary COB claims
Submit the claim to the primary insurer and then submit the balance for secondary processing to us once the Electronic Remittance Advice (ERA) is available. Please do not send us the paper Explanation of Benefits (EOB) as the ERA is sufficient.

Claims with a TIN/Suffix
If you submit claims using your Legacy Provider ID (TIN + suffix):

Clearinghouse-submitted claims submitted: Include the TIN+suffix (i.e. “123456789A”) in Loop 2010BB, REF*G2 segment.
NaviNet-submitted claims: The TIN+suffix should be entered in the “33, Blue Cross Number” field.

Corrected/ Adjusted/ Resubmitted Claims
The following information must be included to indicate that the 837 transaction is an adjustment request.

Frequency code:
For institutional claims - the 3rd position of the type of bill (values 5, 7,8, F, G, H, I, J, K, M or N).
For professional - the frequency code (values 7 or 8) associated with the place of service.
Professional requests must include the adjustment reason and narrative explaining why the claim is being adjusted. For example, the adjustment reason could be “number of units” and additional narrative could be “units billed incorrectly, changed units from 010 to 001.”
Institutional adjustment requests must contain the adjustment reason and narrative explaining why the claim is being adjusted. For example, the adjustment reason could be "subscriber ID corrections," and the additional narrative could be "transposed subscriber ID, correct ID is 12345678 for John Smith, DOB 11-22-1970."
Original reference number: Claim number (ICN/DCN) of the originally adjudicated claim found on your remittance advice.

Timely Filing of Claims
If you noticed that Horizon BCBSNJ did not receive a claim that you previously sent, we urge that you resend this claim electronically to expedite the processing.

Nonparticipating Providers
Nonparticipating providers should submit claims electronically using our Payer ID 22099.