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Horizon NJ Health

Learn about billing, taxonomy codes, electronic funds transfer, and more at the Horizon NJ TotalCare Billing Seminar on April 12, 2017. Discover Horizon NJ TotalCare's benefits and service area.

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Horizon NJ Health

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  1. Horizon NJ Health NJAAHAM Semi Annual Billing Seminar April 12, 2017

  2. Agenda • Horizon NJ TotalCare (HMO SNP) • Billing • Taxonomy Codes • Electronic Billing COB • J&Q Codes • Corrected Claims • Paper Claims • Electronic Funds Transfer (EFT) Enrollment • Navinet Advanced Referral Module • Q&A

  3. Horizon NJ TotalCare (HMO SNP) • Effective date of 1/1/2017 • Providers are participating via contract amendment • This new plan combines all covered Medicare and Medicaid managed care benefits into one health plan • Member ID includes YKU prefix • Zero cost sharing for most covered services • PCP selection required

  4. Horizon NJ TotalCare (HMO SNP) Service Area Horizon NJ TotalCare (HMO SNP) serves the following counties: 1. Atlantic 2. Cumberland 3. Essex 4. Gloucester 5. Hudson 6. Hunterdon 7. Mercer 8. Monmouth 9. Morris 10. Passaic 11. Salem 12. Somerset 13. Sussex 14. Union 15. Warren

  5. Horizon NJ TotalCare (HMO SNP) • All members are enrolled in the care management program • Referrals and prior authorizations for certain services • No out of network services except for emergencies • Members must reside in the 15 counties to be eligible to enroll • Members can receive services in any county where there are DSNP network providers

  6. Horizon NJ Total Care Sample ID Card

  7. Horizon NJ TotalCare (HMO SNP) Contact Information

  8. Billing: Taxonomy Codes • All claims must be submitted with taxonomy, NPI and Tax Identification number. (Atypical providers are excluded) • Effective 4/1/17, claims that are submitted without this information will be denied • Additional claim submission guidance is available in Section 9 of the Physician and Health Care Professional Manual, located at horizonNJhealth.com

  9. Electronic Billing: Coordination of Benefits • Secondary/COB Claims do not need to be submitted via paper • Please use the following COB loops:

  10. Billing: J&Q Codes • When billing J and Q codes all three elements must be included: • NDC • Unit of measure • Quantity • Utilize the NJMMIS look up tool to verify information before submission of claims: https://www.njmmis.com/ndcLookup.aspx (Physician Administered Drugs - UMO)

  11. Billing: Filing Corrected Claims • Electronic Claims: • This is the preferred method of submitting corrected claims • Use “7” for replacement of a prior claim utilizing bill type in loop 2300, CLM05-03 (837P) • Include the original claim number in segment REF01=F8 and REF02=the original claim number; no dashes or spaces • Include the Horizon NJ Health claim number in order to submit your claim with the 7 • Bill all services, not just the services that need corrections • For guidance please refer 2017 Provider Manual Section 9.3.5

  12. Billing: Paper Claims Horizon NJ Health does not accept handwritten or black & white claims REJECT 123 MAIN ST. APPROVE

  13. 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

  14. EFT Enrollment - Electronic Fund Transfer • 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 Link for form: http://www.horizonnjhealth.com/for-providers/resources/forms/emdeon-electronic-funds-transfer-forms

  15. Navinet Advanced Referral Module • The Advanced Referral module, a new interface for providers who care for Horizon NJ Health Medicaid and Horizon NJ Total Care (HMO SNP) members, will be available for providers • This new interface will employ a form-based search which will allow you to search using any of the following criteria: Address, City, State, ZIP Group Name NPI (Group or Individual) Provider Name Specialty

  16. Q & A

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