www horizon NJhealth com Horizon NJ Health HORIZON

www. horizon. NJhealth. com Horizon NJ Health HORIZON NJ HEALTH NJAAHAM Semi Annual Payer Seminar November 7, 2017 1

www. horizon. NJhealth. com Horizon NJ Health Agenda § § § Claim Update EFT Enrollment Electronic Billing- Coordination of Benefits Provider Demographic Updates NDC Billing Claims Appeals • § Navinet- appeal status Self-Service Tools 2

www. horizon. NJhealth. com Horizon NJ Health EFT Enrollment - Electronic Fund Transfer § We encourage all Horizon NJ Health providers who have not yet begun to receive their payments using Electronic Funds Transfer (EFT) to sign up § Advantages: § With EFT, your reimbursement cycle will be accelerated, since providers can receive EFT payments more quickly than check payments sent through the mail § Payments can be distributed more securely by virtually eliminating check payments lost in the mail, and this can help increase cash flow. In most situations, funds are available on the date the payment is credited to the provider's bank account • Administered by Change Healthcare • Dial 1 -866 -506 -2830, option 1 for more information Email or visit the Horizon NJ Heath online to sign up Email eftenrollment@changehealthcare. com. Or Link form: http: //www. horizonnjhealth. com/for-providers/resources/forms/emdeon-electronic-funds-transfer-forms 3

www. horizon. NJhealth. com Horizon NJ Health Electronic Billing: Coordination of Benefits § Secondary/COB Claims do not need to be submitted via paper § Please use the following COB loops: Loop Description Reported Data 2320 Other Subscriber Information Name of Primary 2330 A Other Subscriber Name of Subscriber 2330 B Other Payer Name Payment Date From Line Adjudication Information Other Insurance 2340 Payment 4

www. horizon. NJhealth. com Horizon NJ Health Provider Demographic Updates 5

www. horizon. NJhealth. com Horizon NJ Health Provider Demographic Updates 6

www. horizon. NJhealth. com Horizon NJ Health NDC- National Drug Code Billing § Claim will be rejected if NDC data is missing incomplete, or has an invalid unit/basis of measurement if a J code or Q code is submitted § Utilize NJMISS to cross reference correct drug code 7

www. horizon. NJhealth. com Horizon NJ Health NDC Billing www. NJMMIS. com Physician Administered Drugs (UOM) 8

www. horizon. NJhealth. com Horizon NJ Health NDC Billing Fill in NDC & Date of Service 9

www. horizon. NJhealth. com Horizon NJ Health NDC Billing RESULTS Use Correct Unit Of Measure when Billing 10

www. horizon. NJhealth. com Horizon NJ Health Claims Appeal § § § All claim appeals must be initiated on the applicable appeal application form created by the Department of Banking and Insurance. The appeal must be received by Horizon NJ Health within 90 calendar days following receipt by the physician, facility or health care professional of the payer’s claim determination. To file a claim appeal, a physician or health care professional must send the appeal application form, which is available at horizon. NJhealth. com/for-providers, and any supporting documentation to Horizon NJ Health using one of the following methods: 11

www. horizon. NJhealth. com Horizon NJ Health Claims Appeal Status § Appeal Status can be checked by using Navinet with Administrative Reports 12

www. horizon. NJhealth. com Horizon NJ Health Claims Status on Navinet Complete Fields With * Provider Service Date 13

www. horizon. NJhealth. com Horizon NJ Health Self Service Tools Please refer to our website www. horizonnjhealth. com under the “For Providers” tab to: · Access our Physician and Healthcare Professional Manual · Verify provider status, view provider profile, and obtain your PIN (Provider ID number) via Provider Directory · Updates and Announcements · Frequently used forms and guides Fee schedule Request: Include provider’s/group’s name, TIN, provider ids, agreement ids, and specialty with top 25 codes Credentialing Status: Email inquiry directly to credentialing at PCS_Credentialing_Mailbox@Horizonblue. com. Allow 48 hours for a response Provider Service: 1 -800 -682 -9091 14

www. horizon. NJhealth. com Horizon NJ Health Q&A 15