1. Topaz Webb MLTSS Network Relations Specialist MLTSS Network Relations
Horizon NJ Health Presentation For Home Care Association of New Jersey April 24, 2015
Topaz Webb
MLTSS Network Relations Specialist
MLTSS Network Relations

2. Who We Are
New Jersey’s largest Medicaid managed health care company with more than 800,000 members
Servicing all 21 counties in New Jersey
NCQA Health Plan Accredited

3. Prior Authorization
Authorizations created when care plan is agreed upon
Servicing provider is identified and confirmed
Authorization letter is faxed to provider

4. Claims Submission Home Based Supportive Care
Bill with HIPAA compliant codes:
S5130 (modifier , if applicable)
MLTSS PDN
T1000 UA – Combination RN & LPN
T1002 UA - RN
T1003 UA - LPN
All claims are billed on a HCFA 1500
Units are billed in 15 minute increments
Include you NPI and HNJH Provider ID
Submitted electronically thru Emdeon or via mail to:
Horizon NJ Health Claims Processing Department P.O. Box London, KY 40742

5. Claims Payment Claims are processed twice a week
Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA-835) via Emdeon
To enroll in Emdeon EFT, please visit or contact Emdeon at

6. How to Check Claim Status
Call Provider Services Hotline:
Access claims status online through NaviNet.net 6

7. Claim Appeals
Please use the Health Care Provider Application to Appeal a Claims Determination form to submit a claim appeal. This can be found on our website at:
Claim appeals may be submitted via mail within 90 days of denial by:
Mail:  Horizon NJ Health           Claim Appeals           P.O. Box           Newark, NJ

8. Critical Incident Reporting
Initial report must be verbally made within one business day.
Written report must be received within two business days.
Contracted providers must immediately (not to exceed one business day) take steps to prevent further harm to any and all members and respond to emergency needs of members.
Call
MLTSS Member Services: OR
MLTSS Provider Services:
Mail Report to:
Horizon NJ Health
Attention: Quality Department, MLTSS Complaints Unit
210 Silvia Street
West Trenton, NJ 08628

9. Critical Incident Reporting (continued)
Providers with a Critical Incident are required to conduct an internal Critical Incident investigation and submit a report on the investigation within 15 calendar days
Providers are still required to report Critical Incidents to the state directly

10. Provider Demographic Changes
Request to Change Information Form
By Fax:
By Mail:
Send a letter (on letterhead) OR
Request to Change Information Form to:
Horizon NJ Health
Professional Contracting and Servicing Department
210 Silvia Street
West Trenton, NJ 08628

11. Provider Resources www.horizonnjhealth.com/provider
Provider Services:
MLTSS Claims Inquiries:
Emdeon Customer Care:
NaviNet Customer Care:

12. Contact Us Dedicated Provider Relations Staff Amy Durkin
MLTSS Provider Relations Coordinator
Topaz Webb
MLTSS Provider Relations Specialist
Marsha A. Gittens-Lee
Manager, MLTSS Network Relations

13. Questions?