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.
- Please save files in one of the following electronic formats: .pdf; .jpeg; .gif; or .png.
- Please format file names using ALL CAPS
(except for the optional lower-case letter noted in step 3.4 below). - 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.
- ZIP file names should be formatted in ALL CAPS.
- Please include the following required file name elements, each separated by an underscore mark:
- 2.1.
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. - 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_MMDDYYY_CARE.zip
- TIN_MMDDYYY_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.
- 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.
- 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.