NJAAHAM Semi Annual Payer Seminar November 7, 2017 HORIZON NJ HEALTH NJAAHAM Semi Annual Payer Seminar November 7, 2017

Agenda Claim Update EFT Enrollment Electronic Billing- Coordination of Benefits Provider Demographic Updates NDC Billing Claims Appeals Navinet- appeal status Self-Service Tools

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 for form: http://www.horizonnjhealth.com/for-providers/resources/forms/emdeon-electronic-funds-transfer-forms

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 Insurance 2330A Other Subscriber Name Name of Subscriber 2330B Other Payer Name Payment Date From Other Insurance 2340 Line Adjudication Information Payment

Provider Demographic Updates

Provider Demographic Updates

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

NDC Billing www.NJMMIS.com Physician Administered Drugs (UOM)

NDC Billing Fill in NDC & Date of Service

NDC Billing RESULTS Use Correct Unit Of Measure when Billing

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 horizonNJhealth.com/for-providers, and any supporting documentation to Horizon NJ Health using one of the following methods:

Claims Appeal Status Appeal Status can be checked by using Navinet with Administrative Reports

Claims Status on Navinet Complete Fields With * Provider Service Date

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 48hours for a response Provider Service: 1-800-682-9091

Q & A