Electronic Claim Adjustments
Electronic Claim Adjustments
Horizon Blue Cross Blue Shield of New Jersey requests that claim adjustment requests be sent electronically via standard HIPAA 837 transaction sets. Submitting standard 837P (professional) and 837I (institutional) transactions allows Horizon BCBSNJ to address your adjustment requests quickly.
Adjustment requests may be submitted electronically for:
- Local professional, institutional and dental claims, including the State Health Benefits Program (SHBP).
- Federal Employee Program® (FEP) professional, institutional and dental claims.
- BlueCard® professional and institutional claims.*
*BlueCard claim adjustment requests to change subscriber ID, provider Tax ID Number or provider suffix cannot be submitted electronically. Please submit these requests by mail.
If you have questions, please contact the Horizon BCBSNJ eService Desk at 1-888-334-9242 or via email at HorizonEDI@HorizonBlue.com. Representatives are available Monday through Friday from 7 a.m. to 6 p.m., ET.
837 Adjustment Request Required Information
The following information is required within 837 Adjustment Request transactions. Please work with your vendor or clearinghouse to ensure your electronic transactions are being submitted correctly.
| Frequency Code |
The appropriate Frequency Code must be present on 837 transactions to indicate the information submitted is for a claim adjustment.
Institutional claim adjustment submissions:
The third position of the Type of Bill (values 5, 7, 8, F, G, H, I, J, K, M or N) indicates this transaction is an adjustment. Professional and dental claim adjustment submissions:
The Frequency Code (values 7 or 8) associated with the Place of Service indicates this transaction is an adjustment. |
| Claim Note | Professional and dental claim electronic adjustment requests must include the Adjustment Reason and Narrative explaining why the claim is being adjusted. (Example: Adjustment Reason: Number of units; Narrative: Units billed incorrectly, changed units from 010 to 001). |
| Billing Note | Institutional claim electronic adjustment requests must include the Adjustment Reason and Narrative explaining why the claim is being adjusted. (Example: Adjustment Reason: Subscriber ID corrections; Narrative: Transposed subscriber ID, correct Sub ID is 12345678 for John Smith, DOB 11-22-1970). |
| Original Reference Number (ORN) | All 837 electronic adjustment transactions must include the claim number of the originally adjudicated claim found on your remittance advice (i.e., the ICN/DCN of the claim you want adjusted). |
BlueCard® and Federal Employee Program® (FEP®) are registered marks of the Blue Cross and Blue Shield Association
