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COVID-19 InformationCOVID-19 Information
- COVID-19 Information
- 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
- Update: Prior Authorization Requirements for Inpatient Admissions and Post-Acute Facility Admissions to be ReinstatedUpdate: Prior Authorization Requirements for Inpatient Admissions and Post-Acute Facility Admissions to be Reinstated
- COVID-19 vaccine administration reimbursement at UCCsCOVID-19 vaccine administration reimbursement at UCCs
- COVID-19 vaccines available in Essex County – Information for your staff and patientsCOVID-19 vaccines available in Essex County – Information for your staff and patients
- Reimbursement Policy effective January 1, 2021: Add-on Payment for COVID-19 Diagnostic Testing Run on High Throughput Technology (U0005)Reimbursement Policy effective January 1, 2021: Add-on Payment for COVID-19 Diagnostic Testing Run on High Throughput Technology (U0005)
- 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
- Waiving Prior Authorization Requirements for Emergent In-Network Inpatient Admissions and Post-Acute Facility AdmissionsWaiving Prior Authorization Requirements for Emergent In-Network Inpatient Admissions and Post-Acute Facility Admissions
- 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
- Cost Sharing on Claims with Multiple DiagnosesCost Sharing on Claims with Multiple Diagnoses
- Dates for Certain Prior Authorization Waivers Further ExtendedDates for Certain Prior Authorization Waivers Further Extended
- Dates for Prior Authorization Waivers ExtendedDates for Prior Authorization Waivers Extended
- New Laboratory COVID-19 Antibody Testing Codes: 86328 and 86769New Laboratory COVID-19 Antibody Testing Codes: 86328 and 86769
- Help for health care professionalsHelp for health care professionals
- COVID-19 Update: Medical Policy Revisions & ImplementationsCOVID-19 Update: Medical Policy Revisions & Implementations
- 72 Doctors, Nurses, Pharmacists and Health Clinicians from Horizon BCBSNJ Answer Governor Murphy’s “HealthCare Professionals Call to Serve”72 Doctors, Nurses, Pharmacists and Health Clinicians from Horizon BCBSNJ Answer Governor Murphy’s “HealthCare Professionals Call to Serve”
- New Jersey Pandemic Relief Fund Efforts Get $2 Million Boost from HorizonNew Jersey Pandemic Relief Fund Efforts Get $2 Million Boost from Horizon
- A special message from Howard A. Cutler, Vice President, Healthcare DeliveryA special message from Howard A. Cutler, Vice President, Healthcare Delivery
- Behavioral Health Continuity During the COVID-19 Public Health EmergencyBehavioral Health Continuity During the COVID-19 Public Health Emergency
- COVID-19 Frequently Asked QuestionsCOVID-19 Frequently Asked Questions
- Waiving Pre-Certification/Prior Authorization requirements for Physical Health Post-Acute Facility AdmissionsWaiving Pre-Certification/Prior Authorization requirements for Physical Health Post-Acute Facility Admissions
- Horizon BCBSNJ Commits $2.5 Million for Masks, Face Shields, Food and Social Services to Protect Our Communities and Our Health ProfessionalsHorizon BCBSNJ Commits $2.5 Million for Masks, Face Shields, Food and Social Services to Protect Our Communities and Our Health Professionals
- COVID-19 Update: Authorizations Waived for Oxygen Following ER DischargeCOVID-19 Update: Authorizations Waived for Oxygen Following ER Discharge
- 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
- Provisionally Join Horizon BCBSNJ Network(s) to Assist with the COVID-19 PandemicProvisionally Join Horizon BCBSNJ Network(s) to Assist with the COVID-19 Pandemic
- Waiving Pre-Certification/Prior Authorization requirements for acute inpatient facility admissionsWaiving Pre-Certification/Prior Authorization requirements for acute inpatient facility admissions
- 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
- COVID-19 CPT testing codesCOVID-19 CPT testing codes
- Eliminating Cost Sharing Related to COVID-19 Testing and EvaluationEliminating Cost Sharing Related to COVID-19 Testing and Evaluation
- Staying Informed: COVID-19 CoronavirusStaying Informed: COVID-19 Coronavirus
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Interactive Voice Response System (IVR)Interactive Voice Response System (IVR)
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- Referral Process Using the Interactive Voice Response SystemReferral Process Using the Interactive Voice Response System
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Surgical and Implantable Device Management ProgramSurgical and Implantable Device Management Program
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Cardiac ServicesCardiac 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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Orthopedic ServicesOrthopedic Services
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- Safety and Quality Award Program Q&ASafety and Quality Award Program Q&A
- Surgical and Implantable Device Management Program Orthopedic Services Frequently Asked Questions Updated: March 25, 2021Surgical and Implantable Device Management Program Orthopedic Services Frequently Asked Questions Updated: March 25, 2021
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- Medical Policy Criteria and GuidelinesMedical Policy Criteria and Guidelines
- PA/MND ProcessPA/MND Process
- Using Out-of-Network Providers in Surgical ServicesUsing Out-of-Network Providers in Surgical Services
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Claim Submission & BillingClaim Submission & Billing
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Demographic UpdatesDemographic Updates
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- The Importance of Demographic UpdatesThe Importance of Demographic Updates
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- Initiating Demographic UpdatesInitiating Demographic Updates
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Inquiries, Complaints & AppealsInquiries, Complaints & Appeals
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Medical PoliciesMedical Policies
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Administrative PoliciesAdministrative Policies
- Administrative Policies
- 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
- EDI and NaviNet Claims Submission RequirementEDI and NaviNet Claims Submission Requirement
- Electronic Funds Transfer (EFT)Electronic Funds Transfer (EFT)
- Material Adverse Change (MAC) Notification PolicyMaterial Adverse Change (MAC) Notification Policy
- Medical Records Documentation StandardsMedical Records Documentation Standards
- Medicare Advantage ReadmissionMedicare Advantage Readmission
- Never EventsNever Events
- Out-of-Network Referral PolicyOut-of-Network Referral Policy
- 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
- Practitioner Office Site Quality and Medical Record Keeping StandardsPractitioner Office Site Quality and Medical Record Keeping Standards
- Provider Directory ManagementProvider Directory Management
- Provider Outlier Program Frequently Asked QuestionsProvider Outlier Program Frequently Asked Questions
- Retainer Based MedicineRetainer Based Medicine
- 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
- Use of Horizon Hospital Network Performance DataUse of Horizon Hospital Network Performance Data
- Use of Practitioner Performance DataUse of Practitioner Performance Data
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- BlueCard Medical PoliciesBlueCard Medical Policies
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Reimbursement Policies & GuidelinesReimbursement Policies & Guidelines
- Reimbursement Policies & Guidelines
- 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)
- After-hours and Weekend CareAfter-hours and Weekend Care
- Ambulance ServicesAmbulance Services
- Ambulatory Electrocardiographic MonitoringAmbulatory Electrocardiographic Monitoring
- Anesthesia Reimbursement GuidelinesAnesthesia Reimbursement Guidelines
- ASC Multiple Procedure MethodologyASC Multiple Procedure Methodology
- Assistant at SurgeryAssistant at Surgery
- Balloon SinuplastyBalloon Sinuplasty
- Bariatric Surgery Billed With Hiatal Hernia RepairBariatric Surgery Billed With Hiatal Hernia Repair
- Bilateral ProceduresBilateral Procedures
- Billing Guidelines for Maternity ServicesBilling Guidelines for Maternity Services
- Cardiac Event DetectionCardiac Event Detection
- Cardiovascular Implant Device Monitoring ServicesCardiovascular Implant Device Monitoring Services
- Casting, Strapping and SplintsCasting, Strapping and Splints
- Chemotherapy AdministrationChemotherapy Administration
- Chronic Care Management ServicesChronic Care Management Services
- Claim Editing PoliciesClaim Editing Policies
- Claims Requiring Additional DocumentationClaims Requiring Additional Documentation
- ClaimsXten Editing RulesClaimsXten Editing Rules
- Clinical Trials Support ProgramClinical Trials Support Program
- Co-Surgeon ReimbursementCo-Surgeon Reimbursement
- Colonoscopy with Modifier 59Colonoscopy with Modifier 59
- Conscious SedationConscious Sedation
- Consultation Services PaymentConsultation Services Payment
- Consumable Medical SuppliesConsumable Medical Supplies
- 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
- Determination of Refractive StateDetermination of Refractive State
- Diabetic Screening ServicesDiabetic Screening Services
- Diabetic SuppliesDiabetic Supplies
- Distinct Procedural Service Modifiers (59, XE, XP, XS, XU)Distinct Procedural Service Modifiers (59, XE, XP, XS, XU)
- DME Rent to PurchaseDME Rent to Purchase
- Drug and Immunization PricingDrug and Immunization Pricing
- Duplex ScanningDuplex Scanning
- Drug Wastage – Modifier JWDrug Wastage – Modifier JW
- Duplicate Claim Logic for Independent Laboratory ServicesDuplicate Claim Logic for Independent Laboratory Services
- 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
- Frequency of Care Coordination Services and ESRD ProceduresFrequency of Care Coordination Services and ESRD Procedures
- Frequency of G0179Frequency of G0179
- Hip ArthroscopyHip Arthroscopy
- Hospital Non-Patient Laboratory ServicesHospital Non-Patient Laboratory Services
- Hot or Cold Pack TherapyHot or Cold Pack Therapy
- Inpatient ConsultationsInpatient Consultations
- 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
- Outpatient ConsultationsOutpatient Consultations
- 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
- Site of Service DifferentialSite of Service Differential
- Smoking CessationSmoking Cessation
- Status N CodesStatus N Codes
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Telemedicine ServicesTelemedicine Services
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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
- Urinalysis with Evaluation and Management (E&M) ServicesUrinalysis with Evaluation and Management (E&M) Services
- Urine Drug Screening/TestingUrine Drug Screening/Testing
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Utilization ManagementUtilization Management
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- PT/OT Outpatient Prior Authorization for Horizon Medicare Advantage PlansPT/OT Outpatient Prior Authorization for Horizon Medicare Advantage Plans
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Services Requiring Prior AuthorizationServices Requiring Prior Authorization
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- Prior Authorization Procedure Search ToolPrior Authorization Procedure Search Tool
- BlueCard MembersBlueCard Members
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- UNITE HERE HEALTHUNITE HERE HEALTH
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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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