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How to Submit Supplemental Data to Horizon

Review detailed instructions about the required naming conventions and the processes that must be followed to submit that documentation to us.

  • To help ensure that we can organize and easily identify submitted information, we ask that you comply with the following document formatting and naming guidelines.

    1. Please save files in one of the following electronic formats: .pdf; .jpeg; .gif; or .png.
    2. Please format file names using ALL CAPS
      (except for the optional lower-case letter noted in step 3.4 below).
    3. Please include the following required file name elements, each separated by an underscore mark:
      • 3.1.

        Member Horizon ID Number
        Do not include any three-character prefixes.

      • 3.2.

        HEDIS Measure Abbreviation
        Please use the appropriate Measure Abbreviation(s) noted in the table below.



        If the same documentation suffices for multiple HEDIS measures, please include all abbreviations in your document name (without spaces). Please do not submit the same chart multiple times.


        Abbreviation Adult HEDIS Measure
        CWP Appropriate Testing for Pharyngitis
        BCS Breast Cancer Screening
        CBP Controlling High Blood Pressure
        CCS Cervical Cancer Screening
        CHL Chlamydia Screening in Women
        COL Colorectal Cancer Screening
        HBD Hemoglobin A1c Control for Patients with Diabetes
        EED Eye Exam for Patients with Diabetes
        KED Kidney Health Evaluation for Patients with Diabetes
        BPD Blood Pressure Control for Patients with Diabetes
        COAP Care for Older Adults: Pain Assessment
        COAM Care for Older Adults: Medication Review
        COAF Care for Older Adults: Functional Status
        TRC Transitions in Care: Medication Reconciliation Post Discharge
        PPCPN Prenatal and Postpartum Care: Timeliness of Prenatal Care
        PPCPP Prenatal and Postpartum Care: Postpartum
        Abbreviation Pediatric HEDIS Measure
        IMA Immunizations for Adolescents
        LSC Lead Screening in Children
        EPDST Lead Screening in Children
        WCCB Weight Assessment and Counseling for Nutrition and Physical Activity for Children/ Adolescents: BMI Percentile
        WCCN Weight Assessment and Counseling for Nutrition & Physical Activity for Children/ Adolescents: Counseling for Nutrition
        WCCP Weight Assessment and Counseling for Nutrition and Physical Activity for Children/ Adolescents: Counseling for Physical Activity
        CIS10 Childhood Immunization Status
      • 3.3.

        Submission date
        Please use a MMDDYYYY format.

        If you submit additional documentation for a particular patient/measure, please ensure that you use the “current” submission date (rather than the original submission date) in your file name. This will prevent our confusing initial documentation and subsequently submitted documentation.

      • 3.4.

        Practice Name Acronym
        Please include the Practice Name Acronym assigned to you for all submitted HEDIS documentation.
        If you are not aware of your specific Practice Name Acronym, please contact your Clinical Quality Improvement Liaison.

        Additionally:
        If your practice participates in a specialty Results and Recognition (R&R) Program, please also include the appropriate lower-case letter (see below) right after your Practice Name Acronym.


        Abbreviation R&R Program
        e Endocrinology
        c Cardiology
        p Ophthalmology
        o Women’s Health/OBGYN
      • 3.5.

        Member Insurance Line of Business
        Please use one of the abbreviations noted in the table below to identify the type of plan in which the member is enrolled.


        Abbreviation Member Insurance Line of Business
        CAID Medicaid
        CARE Medicare
        BVN Braven Health℠
        COM Commercial
        SNP DSNP
      • 3.6.

        Multiple File Indicator
        If you are not able to save all documentation as a single file, please add underscore 01, 02, etc., to the end of your document name to denote multiple parts of the information submitted for a single member/measure/submission date.

    File Name Examples



    3HZN12345678_CBP_01012022_XYZe_CARE



    The sample File name above includes the elements noted in the table below.


    Abbreviation Member Insurance Line of Business
    Member Horizon ID Number 3HZN12345678
    HEDIS Measure Abbreviation CBP (Controlling High Blood Pressure)
    Submission Date January 1, 2022
    Practice Name Acronym XYZ Practice,
    This practice also participates in the Endocrinology (e) R&R Program
    Member Insurance Line of Business CARE (Medicare)

    3HZN12345678_BCSCOLCBP_03152022_PRAC_CAID_02



    The sample File name above includes the elements noted in the table below.


    Abbreviation Member Insurance Line of Business
    Member Horizon ID Number 3HZN12345678
    HEDIS Measure Abbreviation This document provides information to close gaps for the BCS (Breast Cancer Screening), COL (Colorectal Cancer Screening) and CBP (Controlling High Blood Pressure) measures.
    Submission Date March 15, 2022
    Practice Name Acronym ABC Practice
    Member Insurance Line of Business CAID (Medicaid)
    Multiple File Indicator This document is the second (2) of multiple files 2 submitted for a single member/measure/submission date
  • You may group multiple appropriately named documents in a ZIP file for easier submission. Please group and ZIP documents by member insurance coverage line of business (e.g., Medicaid, Medicare, etc.). Please do not mix multiple lines of business within a single ZIP file.



    ZIP File Naming
    To help ensure that we can organize and easily identify submitted information, we ask that you comply with the following document formatting and naming guidelines.

    1. ZIP file names should be formatted in ALL CAPS.
    2. Please include the following required file name elements, each separated by an underscore mark:
      • 2.1.

        Practice TIN
        Please use your assigned Practice Tax Identification Number

      • 2.2.

        Submission date
        (MMDDYYYY)

      • 2.3.

        Member Insurance Line of Business
        Please use one of the abbreviations below to identify the type of plan in which the members are enrolled.



        And please remember to group and ZIP documents by member insurance coverage line of business. Please do not mix multiple lines of business within a single ZIP file.


        Abbreviation Member Insurance Line of Business
        CAID Medicaid
        CARE Medicare
        BVN Braven Health℠
        COM Commercial
        SNP DSNP

    Please group and ZIP documents by member insurance coverage line of business (e.g., Medicaid, Medicare, etc.). Please do not mix multiple lines of business within a single ZIP file.



    Examples:

    • TIN_MMDDYYYY_CARE.zip
    • TIN_MMDDYYYY_SNP.zip

  • Please use one of the following methods to submit HEDIS documentation to us. Please note documentation that does not following our naming guidelines may be returned to you.

    1. Upload via HorizonDocs (recommended)
      Visit our HorizonDocs webpage for information on accessing and using this tool.

      When using HorizonDocs for the submission of HEDIS documentation, please follow these HEDIS-specific instructions.

      • Select Health Plans on the NaviNet toolbar, then select Horizon NJ Health or Horizon BCBSNJ
      • Under Workflows for this Plan, select HorizonDocs then go to Upload Documents and complete required fields
      • Category: Quality
      • Sub-category: either Medicaid or Medicare Supplemental Data (as applicable)

      Please ensure that your documentation is appropriately named before uploading.

    2. Upload through the Managed File Transfer (MFT)
      If your practice has access to Horizon’s MFT capability, you can simply:
      • Save the documentation to the “Medicare Supplemental Files” or “Medicaid Supplemental Data” sub-folder in the “Partner to Horizon” folder on the MFT site.