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PROVIDERS
COVID-19 Information
COVID-19 Information
COVID-19 Information
Coverage for Out-of-Network COVID-19 Testing Ending
Coverage for Out-of-Network COVID-19 Testing Ending
Code Terminations as the PHE Ends
Code Terminations as the PHE Ends
PHE Update: Prescription Limitation Change for Braven Health, HMO D-SNP and Medicare Part D members
PHE Update: Prescription Limitation Change for Braven Health, HMO D-SNP and Medicare Part D members
Pre-Certification/Prior Authorization requirements for Post-Acute Facility Admissions
Pre-Certification/Prior Authorization requirements for Post-Acute Facility Admissions
Submitting Pharmacy Claims for OTC, At-Home COVID-19 Test Kits
Submitting Pharmacy Claims for OTC, At-Home COVID-19 Test Kits
Submitting Pharmacy Claims for COVID-19 Vaccinations
Submitting Pharmacy Claims for COVID-19 Vaccinations
Antibody testing: FDA and CDC do not recommend use to determine immunity
Antibody testing: FDA and CDC do not recommend use to determine immunity
Reminder: Use correct codes when evaluating for COVID-19
Reminder: Use correct codes when evaluating for COVID-19
Policy Update: Antibody Testing Claims
Policy Update: Antibody Testing Claims
Submitting claims for COVID-19 vaccines delivered in non-traditional medical settings
Submitting claims for COVID-19 vaccines delivered in non-traditional medical settings
For Essential Workers, COVID-19 Treatment Covered Under Workers' Compensation Benefits
For Essential Workers, COVID-19 Treatment Covered Under Workers' Compensation Benefits
COVID-19 Vaccine
COVID-19 Vaccine
COVID-19 vaccines will be covered at 100%
COVID-19 vaccines will be covered at 100%
Coverage for antibody infusion therapy
Coverage for antibody infusion therapy
Reminder: Horizon NJ Health members are not responsible for PPE charges
Reminder: Horizon NJ Health members are not responsible for PPE charges
COVID-19 Frequently Asked Questions
COVID-19 Frequently Asked Questions
Reminder to use specific codes when evaluating for COVID-19
Reminder to use specific codes when evaluating for COVID-19
Referrals no longer required for in-network specialists
Referrals no longer required for in-network specialists
Telemedicine and Telehealth Services Reimbursement Policy
Telemedicine and Telehealth Services Reimbursement Policy
Resources
Resources
Resources
21st Century Cures Act
21st Century Cures Act
Claim Overpayments
Claim Overpayments
Clinical and Preventive Guidelines
Clinical and Preventive Guidelines
Clinical and Preventive Guidelines
Clinical Guidelines
Clinical Guidelines
Credentialing and Recredentialing Responsibilities
Credentialing and Recredentialing Responsibilities
Credentialing and Recredentialing Responsibilities
Credentialing and Recredentialing Policy for Participating Physicians and Healthcare Professionals
Credentialing and Recredentialing Policy for Participating Physicians and Healthcare Professionals
Credentialing and Recredentialing Policy for Ancillary and Managed Long Term Support Service (MLTSS) Providers
Credentialing and Recredentialing Policy for Ancillary and Managed Long Term Support Service (MLTSS) Providers
Demographic Updates
Demographic Updates
Educational Materials
Educational Materials
Educational Materials
Educational Webinars
Educational Webinars
ClaimsXTen FAQs
ClaimsXTen FAQs
Federally Qualified Health Center (FQHC) Resource Guide
Federally Qualified Health Center (FQHC) Resource Guide
How to Submit Claims with Drug-Related (J or Q) Codes
How to Submit Claims with Drug-Related (J or Q) Codes
ClaimsXTen Edit Codes and Messages
ClaimsXTen Edit Codes and Messages
SimpleClaim Training Resources
SimpleClaim Training Resources
How to Correctly Submit Claims with J or Q Codes
How to Correctly Submit Claims with J or Q Codes
Federally Qualified Health Center (FQHC) - Dental Billing Guide
Federally Qualified Health Center (FQHC) - Dental Billing Guide
DAVIS VISION Federally Qualified Health Center (FQHC) – Vision Billing Guide
DAVIS VISION Federally Qualified Health Center (FQHC) – Vision Billing Guide
Focus on Quality
Focus on Quality
Focus on Quality
Advance Directives
Advance Directives
Leading the Way on Lead
Leading the Way on Lead
Well-Being Screening Tool
Well-Being Screening Tool
形式
形式
形式
Behavioral Health Forms
Behavioral Health Forms
Clinical Authorization Forms
Clinical Authorization Forms
COVID Vaccine Form
COVID Vaccine Form
Early and Periodic Screening, Diagnosis and Treatment Exam Forms
Early and Periodic Screening, Diagnosis and Treatment Exam Forms
Electronic Funds Transfer (EFT) Forms
Electronic Funds Transfer (EFT) Forms
形式to Join Our Networks
形式to Join Our Networks
Lead Risk Assessment Form
Lead Risk Assessment Form
OBAT Attestation for Nonparticipating Providers
OBAT Attestation for Nonparticipating Providers
Other Forms
Other Forms
Guides
Guides
HealthSphere
HealthSphere
Helping Patients Understand Their Care
Helping Patients Understand Their Care
Laboratory Corporation of America (LabCorp)
Laboratory Corporation of America (LabCorp)
Medicaid Reimbursement and Billing
Medicaid Reimbursement and Billing
Medicaid Reimbursement and Billing
Medicaid Provider Enrollment Requirements by State
Medicaid Provider Enrollment Requirements by State
MLTSS Provider Resources
MLTSS Provider Resources
MLTSS Provider Resources
MLTSS Bed Type Revenue Codes
MLTSS Bed Type Revenue Codes
Managed Long Term Services & Supports (MLTSS) Orientation
Managed Long Term Services & Supports (MLTSS) Orientation
MLTSS Provider Manual
MLTSS Provider Manual
MLTSS Provider Manual
Section 1 - Introduction
Section 1 - Introduction
Section 2 – Eligibility
Section 2 – Eligibility
Section 3 - MLTSS Overview
Section 3 - MLTSS Overview
Section 4 - Care Management/Authorizations
Section 4 - Care Management/Authorizations
Section 5 - Billing Guide
Section 5 - Billing Guide
Section 6 - Grievance and Appeals Process
Section 6 - Grievance and Appeals Process
Section 7 - Service Departments
Section 7 - Service Departments
Section 8 - Policies and Procedures
Section 8 - Policies and Procedures
Appendix A – Glossary of Terms
Appendix A – Glossary of Terms
Appendix B – Contract Compliance
Appendix B – Contract Compliance
Pharmacy Utilization Management Programs
Pharmacy Utilization Management Programs
Pharmacy Utilization Management Programs
Pharmacy Medical Necessity Determination
Pharmacy Medical Necessity Determination
Maximum Allowable Cost (MAC) Appeal Form
Maximum Allowable Cost (MAC) Appeal Form
Policies
Policies
Policies
Administrative Policies
Administrative Policies
Administrative Policies
预约访问可用性的标准ary Care-Type Providers, Ob/Gyns, Specialists and Behavioral Health Providers
预约访问可用性的标准ary Care-Type Providers, Ob/Gyns, Specialists and Behavioral Health Providers
Digital Member ID Card Policy
Digital Member ID Card Policy
Provider Directory Management
Provider Telephone Access Standards Policy Requirements
Provider Telephone Access Standards Policy Requirements
Medical Policies
Medical Policies
Reimbursement Policies & Guidelines
Reimbursement Policies & Guidelines
Reimbursement Policies & Guidelines
Add-on Payment for COVID-19 Diagnostic Testing Run on High Throughput Technology (U0005)
Add-on Payment for COVID-19 Diagnostic Testing Run on High Throughput Technology (U0005)
Advance Care Planning
Advance Care Planning
Allergy Services
Allergy Services
Ambulance Services
Ambulance Services
Anesthesia Reimbursement Guidelines
Anesthesia Reimbursement Guidelines
Bariatric Surgery Billed With Hiatal Hernia Repair or Gastropexy
Bariatric Surgery Billed With Hiatal Hernia Repair or Gastropexy
Billing Requirements for Clinical Trials
Billing Requirements for Clinical Trials
Brachytherapy Billing Requirements
Brachytherapy Billing Requirements
Breast Pump Reimbursement
Breast Pump Reimbursement
Cardiac Event Detection
Cardiac Event Detection
Care Management Services for Substance Use Disorders
Care Management Services for Substance Use Disorders
Centering Pregnancy Prenatal Care
Centering Pregnancy Prenatal Care
Chiropractic Manipulation Diagnosis Policy
Chiropractic Manipulation Diagnosis Policy
Chronic Care Management
Chronic Care Management
Claim Editing Policy
Claim Editing Policy
Consultation Services Payment
Consultation Services Payment
COVID 19 Antibody Testing
COVID 19 Antibody Testing
Daily Maximum Units for Surgical Pathology and Microscopic Examination
Daily Maximum Units for Surgical Pathology and Microscopic Examination
Diabetic Screening Services
Diabetic Screening Services
Diabetic Supplies
Diabetic Supplies
DIR Services
DIR Services
Distinct Procedural Service Modifiers (59, XE, XP, XS, XU)
Distinct Procedural Service Modifiers (59, XE, XP, XS, XU)
Doula Services
Doula Services
Early Elective Childbirth Deliveries
Early Elective Childbirth Deliveries
Endoscopic Retrograde Cholangiopancreatography (ERCP)
Endoscopic Retrograde Cholangiopancreatography (ERCP)
Evaluation and Management Services billed with Global Radiology, Stress Test, Stress Echo or Myocardial Profusion Imaging
Evaluation and Management Services billed with Global Radiology, Stress Test, Stress Echo or Myocardial Profusion Imaging
False Claims
False Claims
FIDE-SNP Hospital Sequestration Reimbursement
FIDE-SNP Hospital Sequestration Reimbursement
Foot Orthotic Shoes and Inserts
Foot Orthotic Shoes and Inserts
Free Flap Breast Reconstruction
Free Flap Breast Reconstruction
Frequency of Ocular Photography
Frequency of Ocular Photography
Home Health Certification and Re-Certification
Home Health Certification and Re-Certification
Hospice Room and Board Reimbursement
Hospice Room and Board Reimbursement
Laboratory Services Billed by Physicians
Laboratory Services Billed by Physicians
Maternity Reimbursement
Maternity Reimbursement
Maximum Units Policy on Hearing Aid Batteries
Maximum Units Policy on Hearing Aid Batteries
Medical Nutrition Therapy
Medical Nutrition Therapy
Modifier JW – Drug Waste
Modifier JW – Drug Waste
Modifier 22 – Increased Procedural Services
Modifier 22 – Increased Procedural Services
Modifier 50 – Bilateral and LT/RT
Modifier 50 – Bilateral and LT/RT
Modifier 52 – Reduced Services
Modifier 52 – Reduced Services
Modifier 53 – Discontinued Procedures
Modifier 53 – Discontinued Procedures
Modifier 57 – Decision for Surgery
Modifier 57 – Decision for Surgery
Modifier 62 – Two Surgeons
Modifier 62 – Two Surgeons
Modifier 66- Surgical Team
Modifier 66- Surgical Team
Modifier 73 - Discontinued Outpatient Procedure Prior to the Administration of Anesthesia
Modifier 73 - Discontinued Outpatient Procedure Prior to the Administration of Anesthesia
Modifier 76- Repeat Procedure or Service by Same Physician
Modifier 76- Repeat Procedure or Service by Same Physician
Modifier 77- Repeat Procedure or Service by Another Physician
Modifier 77- Repeat Procedure or Service by Another Physician
Modifier 78 – Unplanned Return to the OR
Modifier 78 – Unplanned Return to the OR
Modifiers 80, 81, 82 and AS – Assistant Surgeon
Modifiers 80, 81, 82 and AS – Assistant Surgeon
Multiple Diagnostic Cardiovascular Procedures
Multiple Diagnostic Cardiovascular Procedures
Multiple Diagnostic Ophthalmology Procedures
Multiple Diagnostic Ophthalmology Procedures
Multiple Procedure Reduction
Multiple Procedure Reduction
Mutually and Non-Mutually Exclusive NCCI Edits
Mutually and Non-Mutually Exclusive NCCI Edits
Ophthalmology Services
Ophthalmology Services
Outpatient Facility Code Edits: Revenue Codes
Outpatient Facility Code Edits: Revenue Codes
Outpatient Services Prior to Admission or Same Day Surgery
Outpatient Services Prior to Admission or Same Day Surgery
Post Payment Documentation Requests for Facility Claims
Post Payment Documentation Requests for Facility Claims
Pre-Payment Coding Reviews Documentation Requests
Pre-Payment Coding Reviews Documentation Requests
Pre-Payment Documentation Requests for Facility Claims
Pre-Payment Documentation Requests for Facility Claims
Preventative Medicine Services with Auditory Screening
Preventative Medicine Services with Auditory Screening
Preventive Medicine Services
Preventive Medicine Services
PT/OT/ST Services
PT/OT/ST Services
Pulmonary Diagnostic Procedures when billed with Evaluation and Management Codes
Pulmonary Diagnostic Procedures when billed with Evaluation and Management Codes
Reimbursement of S0302
Reimbursement of S0302
Self-Help/Peer Support Billing Guidelines
Self-Help/Peer Support Billing Guidelines
Smoking Cessation
Smoking Cessation
Specimen Collection Travel Allowance
Specimen Collection Travel Allowance
Split Surgical Services (Modifiers -54, -55 and -56)
Split Surgical Services (Modifiers -54, -55 and -56)
Telemedicine and Telehealth
Telemedicine and Telehealth
Telemedicine and Telehealth
Telemedicine Reimbursement Policy: Temporary Update
Telemedicine Reimbursement Policy: Temporary Update
过渡Care Planning
过渡Care Planning
Ulcer Debridement and Ulcer Stages
Ulcer Debridement and Ulcer Stages
Unlisted Codes
Unlisted Codes
Urgent Care Center Billing Requirements
Urgent Care Center Billing Requirements
Urine Drug Testing
Urine Drug Testing
Health Services Policies – Clinical Affairs, Dental, Pharmacy, Quality, Utilization Management
Health Services Policies – Clinical Affairs, Dental, Pharmacy, Quality, Utilization Management
Provider Administrative Manual
Provider Administrative Manual
State of New Jersey Contractual Requirements
State of New Jersey Contractual Requirements
Surgical and Implantable Device Management Program
Surgical and Implantable Device Management Program
Surgical and Implantable Device Management Program
Cardiac Services
Cardiac Services
Orthopedic Services
Orthopedic Services
Spine Services
Spine Services
Timely Filing Requirements
Timely Filing Requirements
Timely Filing Requirements
Billing Guide
Billing Guide
Electronic Data Interchange (EDI)/Electronic Funds Transfer (EFT)
Electronic Data Interchange (EDI)/Electronic Funds Transfer (EFT)
Emdeon Electronic Funds Transfer (EFT) Forms
Emdeon Electronic Funds Transfer (EFT) Forms
Claims Addresses
Claims Addresses
ClaimsXTen FAQs
ClaimsXTen FAQs
Tips for Claims/Encounters Filing
Tips for Claims/Encounters Filing
NIA Claims Matrix
NIA Claims Matrix
False Claims Policy
False Claims Policy
Utilization Management
Utilization Management
Utilization Management
Utilization Management Appeal Process for Administrative Denials
Utilization Management Appeal Process for Administrative Denials
Digital Member ID Cards
Digital Member ID Cards
Programs
Programs
Programs
Care Management
Care Management
Dental
Dental
Dental
Caries Risk Assessment
Caries Risk Assessment
Clinical Criteria Grid
Clinical Criteria Grid
Clinical Criteria Grid
NJ FamilyCare Dental Services Clinical Criteria Policy (effective January 1, 2023)
NJ FamilyCare Dental Services Clinical Criteria Policy (effective January 1, 2023)
Noncompliant members
Noncompliant members
Prior Authorization
Prior Authorization
Role of the Managed Care Organization (MCO)
Role of the Managed Care Organization (MCO)
SKYGEN USA
SKYGEN USA
Disease Management Programs to Help Your Patients
Disease Management Programs to Help Your Patients
Disease Management Programs to Help Your Patients
Program for Elderly Members
Program for Elderly Members
eviCore healthcare
eviCore healthcare
eviCore healthcare
Contrast Agents and Radiopharmaceuticals 2023
Contrast Agents and Radiopharmaceuticals 2023
MPPR Logic 2023
MPPR Logic 2023
Radiology Imaging Program Questions and Answers
Radiology Imaging Program Questions and Answers
Fluoride Varnish Program
Fluoride Varnish Program
Focus on Risk Adjustment
Focus on Risk Adjustment
Horizon Behavioral Health
Horizon Behavioral Health
Horizon Behavioral Health
About the Horizon Behavioral Health Program
About the Horizon Behavioral Health Program
Behavioral Health Benefits Grid
Behavioral Health Benefits Grid
Behavioral Health Training Webinars
Behavioral Health Training Webinars
Credentialing & Recredentialing
Credentialing & Recredentialing
Demographic Updates
Demographic Updates
Medical Necessity Criteria
Medical Necessity Criteria
Prior Authorization
Prior Authorization
External Resources
External Resources
Behavioral Health Patient Resources
Behavioral Health Patient Resources
Horizon NJ TotalCare (HMO D-SNP)
Horizon NJ TotalCare (HMO D-SNP)
Horizon NJ TotalCare (HMO D-SNP)
Educational Webinars
Educational Webinars
Cognitive Impairment
Cognitive Impairment
Balance Billing
Balance Billing
FIDE-SNP快速参考指南
FIDE-SNP快速参考指南
Member Benefits
Member Benefits
Medicaid Eligibility
Medicaid Eligibility
Model of Care
Model of Care
Critical Incidents
Critical Incidents
HEDIS
HEDIS
Results & Recognition Program
Results & Recognition Program
VRI
VRI
Managed Long Term Services and Supports
Managed Long Term Services and Supports
Managed Long Term Services and Supports
Welcome
Welcome
MLTSS Service Dictionary
MLTSS Service Dictionary
MLTSS Critical Incident Reporting
MLTSS Critical Incident Reporting
Mom's GEMS Prenatal Program
Mom's GEMS Prenatal Program
New Jersey Integrated Care for Kids (NJ InCK)
New Jersey Integrated Care for Kids (NJ InCK)
Office Based Addiction Treatment (OBAT) Program
Office Based Addiction Treatment (OBAT) Program
Office Based Addiction Treatment (OBAT) Program
Helpful Hints for Office Based Addiction Treatment (OBAT) Claims Submissions
Helpful Hints for Office Based Addiction Treatment (OBAT) Claims Submissions
Office Based Addictions Treatment - Frequently Asked Questions
Office Based Addictions Treatment - Frequently Asked Questions
Quality Improvement Program
Quality Improvement Program
Quality Improvement Program
Quality Resource Center
Quality Resource Center
Results & Recognition Program
Results & Recognition Program
Smoking Cessation
Smoking Cessation
HEDIS®
HEDIS®
CAHPS (Consumer Assessment of Healthcare Providers and Systems)
CAHPS (Consumer Assessment of Healthcare Providers and Systems)
Hospital Acquired Conditions and Serious Adverse Events
Hospital Acquired Conditions and Serious Adverse Events
Join our Networks
Join our Networks
Join our Networks
Physicians and Other Health Care Professionals
Physicians and Other Health Care Professionals
Doula Services Practitioners
Doula Services Practitioners
Ancillary Providers
Ancillary Providers
Ancillary Application Request
Ancillary Application Request
News
News
News
Updates and Announcements
Updates and Announcements
Horizon Pulse Provider Newsletter
Horizon Pulse Provider Newsletter
Horizon Pulse Provider Newsletter
Archives
Archives
Archives
Horizon Pulse - 2023
Horizon Pulse - 2023
Horizon Pulse - 2023
Horizon Pulse March 2023
Horizon Pulse March 2023
Horizon Pulse - 2022
Horizon Pulse - 2022
Horizon Pulse - 2022
Horizon Pulse June 2022
Horizon Pulse June 2022
Horizon Pulse March 2022
Horizon Pulse March 2022
Horizon Pulse November 2022
Horizon Pulse November 2022
Horizon Pulse - 2021
Horizon Pulse - 2021
Horizon Pulse - 2021
Horizon Pulse December 2021
Horizon Pulse December 2021
Horizon Pulse June 2021
Horizon Pulse June 2021
Horizon Pulse 2021, Issue 1
Horizon Pulse 2021, Issue 1
Horizon Pulse - Older
Horizon Pulse - Older
Provider Newsletter, Issue 1, 2023
Provider Newsletter, Issue 1, 2023
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REGISTER TODAY
NAVINET SIGN IN
REGISTER TODAY
COVID-19 Information
For Providers:
1-800-682-9091
Coverage for Out-of-Network COVID-19 Testing Ending
Code Terminations as the PHE Ends
PHE Update: Prescription Limitation Change for Braven Health, HMO D-SNP and Medicare Part D members
Pre-Certification/Prior Authorization requirements for Post-Acute Facility Admissions
Submitting Pharmacy Claims for OTC, At-Home COVID-19 Test Kits
Submitting Pharmacy Claims for COVID-19 Vaccinations
Antibody testing: FDA and CDC do not recommend use to determine immunity
Reminder: Use correct codes when evaluating for COVID-19
Policy Update: Antibody Testing Claims
Submitting claims for COVID-19 vaccines delivered in non-traditional medical settings
For Essential Workers, COVID-19 Treatment Covered Under Workers' Compensation Benefits
COVID-19 Vaccine
COVID-19 vaccines will be covered at 100%
Coverage for antibody infusion therapy
Reminder: Horizon NJ Health members are not responsible for PPE charges
COVID-19 Frequently Asked Questions
Reminder to use specific codes when evaluating for COVID-19
Referrals no longer required for in-network specialists
Telemedicine and Telehealth Services Reimbursement Policy
Resources
For Providers:
1-800-682-9091
21st Century Cures Act
Claim Overpayments
Clinical and Preventive Guidelines
Credentialing and Recredentialing Responsibilities
Demographic Updates
Educational Materials
Focus on Quality
形式
Guides
HealthSphere
Helping Patients Understand Their Care
Laboratory Corporation of America (LabCorp)
Medicaid Reimbursement and Billing
MLTSS Provider Resources
Pharmacy Utilization Management Programs
Policies
Provider Administrative Manual
State of New Jersey Contractual Requirements
Surgical and Implantable Device Management Program
Timely Filing Requirements
Utilization Management
Digital Member ID Cards
Programs
For Providers:
1-800-682-9091
Care Management
Dental
Disease Management Programs to Help Your Patients
eviCore healthcare
Fluoride Varnish Program
Focus on Risk Adjustment
Horizon Behavioral Health
Horizon NJ TotalCare (HMO D-SNP)
Managed Long Term Services and Supports
Mom's GEMS Prenatal Program
New Jersey Integrated Care for Kids (NJ InCK)
Office Based Addiction Treatment (OBAT) Program
Quality Improvement Program
Join our Networks
For Providers:
1-800-682-9091
Physicians and Other Health Care Professionals
Doula Services Practitioners
Ancillary Providers
Ancillary Application Request
News
For Providers:
1-800-682-9091
Updates and Announcements
Horizon Pulse Provider Newsletter
Other Forms - Horizon NJ Health
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COVID-19
Stay informed.
Get the latest information on COVID-19.
21st Century Cures Act
Claim Overpayments
Clinical and Preventive Guidelines
Clinical Guidelines
Credentialing and Recredentialing Responsibilities
Credentialing and Recredentialing Policy for Participating Physicians and Healthcare Professionals
Credentialing and Recredentialing Policy for Ancillary and Managed Long Term Support Service (MLTSS) Providers
Demographic Updates
Educational Materials
Educational Webinars
ClaimsXTen FAQs
Federally Qualified Health Center (FQHC) Resource Guide
How to Submit Claims with Drug-Related (J or Q) Codes
ClaimsXTen Edit Codes and Messages
SimpleClaim Training Resources
How to Correctly Submit Claims with J or Q Codes
Federally Qualified Health Center (FQHC) - Dental Billing Guide
DAVIS VISION Federally Qualified Health Center (FQHC) – Vision Billing Guide
Focus on Quality
Advance Directives
Leading the Way on Lead
Well-Being Screening Tool
形式
Behavioral Health Forms
Clinical Authorization Forms
COVID Vaccine Form
Early and Periodic Screening, Diagnosis and Treatment Exam Forms
Electronic Funds Transfer (EFT) Forms
形式to Join Our Networks
Lead Risk Assessment Form
OBAT Attestation for Nonparticipating Providers
Other Forms
Guides
HealthSphere
Helping Patients Understand Their Care
Laboratory Corporation of America (LabCorp)
Medicaid Reimbursement and Billing
Medicaid Provider Enrollment Requirements by State
MLTSS Provider Resources
MLTSS Bed Type Revenue Codes
Managed Long Term Services & Supports (MLTSS) Orientation
MLTSS Provider Manual
Section 1 - Introduction
Section 2 – Eligibility
Section 3 - MLTSS Overview
Section 4 - Care Management/Authorizations
Section 5 - Billing Guide
Section 6 - Grievance and Appeals Process
Section 7 - Service Departments
Section 8 - Policies and Procedures
Appendix A – Glossary of Terms
Appendix B – Contract Compliance
Pharmacy Utilization Management Programs
Pharmacy Medical Necessity Determination
Maximum Allowable Cost (MAC) Appeal Form
Policies
Administrative Policies
预约访问可用性的标准ary Care-Type Providers, Ob/Gyns, Specialists and Behavioral Health Providers
Digital Member ID Card Policy
Provider Directory Management
Provider Telephone Access Standards Policy Requirements
Medical Policies
Reimbursement Policies & Guidelines
Add-on Payment for COVID-19 Diagnostic Testing Run on High Throughput Technology (U0005)
Advance Care Planning
Allergy Services
Ambulance Services
Anesthesia Reimbursement Guidelines
Bariatric Surgery Billed With Hiatal Hernia Repair or Gastropexy
Billing Requirements for Clinical Trials
Brachytherapy Billing Requirements
Breast Pump Reimbursement
Cardiac Event Detection
Care Management Services for Substance Use Disorders
Centering Pregnancy Prenatal Care
Chiropractic Manipulation Diagnosis Policy
Chronic Care Management
Claim Editing Policy
Consultation Services Payment
COVID 19 Antibody Testing
Daily Maximum Units for Surgical Pathology and Microscopic Examination
Diabetic Screening Services
Diabetic Supplies
DIR Services
Distinct Procedural Service Modifiers (59, XE, XP, XS, XU)
Doula Services
Early Elective Childbirth Deliveries
Endoscopic Retrograde Cholangiopancreatography (ERCP)
Evaluation and Management Services billed with Global Radiology, Stress Test, Stress Echo or Myocardial Profusion Imaging
False Claims
FIDE-SNP Hospital Sequestration Reimbursement
Foot Orthotic Shoes and Inserts
Free Flap Breast Reconstruction
Frequency of Ocular Photography
Home Health Certification and Re-Certification
Hospice Room and Board Reimbursement
Laboratory Services Billed by Physicians
Maternity Reimbursement
Maximum Units Policy on Hearing Aid Batteries
Medical Nutrition Therapy
Modifier JW – Drug Waste
Modifier 22 – Increased Procedural Services
Modifier 50 – Bilateral and LT/RT
Modifier 52 – Reduced Services
Modifier 53 – Discontinued Procedures
Modifier 57 – Decision for Surgery
Modifier 62 – Two Surgeons
Modifier 66- Surgical Team
Modifier 73 - Discontinued Outpatient Procedure Prior to the Administration of Anesthesia
Modifier 76- Repeat Procedure or Service by Same Physician
Modifier 77- Repeat Procedure or Service by Another Physician
Modifier 78 – Unplanned Return to the OR
Modifiers 80, 81, 82 and AS – Assistant Surgeon
Multiple Diagnostic Cardiovascular Procedures
Multiple Diagnostic Ophthalmology Procedures
Multiple Procedure Reduction
Mutually and Non-Mutually Exclusive NCCI Edits
Ophthalmology Services
Outpatient Facility Code Edits: Revenue Codes
Outpatient Services Prior to Admission or Same Day Surgery
Post Payment Documentation Requests for Facility Claims
Pre-Payment Coding Reviews Documentation Requests
Pre-Payment Documentation Requests for Facility Claims
Preventative Medicine Services with Auditory Screening
Preventive Medicine Services
PT/OT/ST Services
Pulmonary Diagnostic Procedures when billed with Evaluation and Management Codes
Reimbursement of S0302
Self-Help/Peer Support Billing Guidelines
Smoking Cessation
Specimen Collection Travel Allowance
Split Surgical Services (Modifiers -54, -55 and -56)
Telemedicine and Telehealth
Telemedicine Reimbursement Policy: Temporary Update
过渡Care Planning
Ulcer Debridement and Ulcer Stages
Unlisted Codes
Urgent Care Center Billing Requirements
Urine Drug Testing
Health Services Policies – Clinical Affairs, Dental, Pharmacy, Quality, Utilization Management
Provider Administrative Manual
State of New Jersey Contractual Requirements
Surgical and Implantable Device Management Program
Cardiac Services
Orthopedic Services
Spine Services
Timely Filing Requirements
Billing Guide
Electronic Data Interchange (EDI)/Electronic Funds Transfer (EFT)
Emdeon Electronic Funds Transfer (EFT) Forms
Claims Addresses
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