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

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

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

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

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

Horizon NJ Total Care Sample ID Card

Horizon NJ TotalCare (HMO SNP) Contact Information TotalCare (HMO SNP) Education Webinars Available on the 2nd and 4th Wednesdays of each month, from February 22, 2017 through June 28, 2017. The seminars will run from 10-11 a.m. and from 1-2 p.m. Where to register http://www.horizonnjhealth.com/for-providers/dsnp-education-webinars Misc. Member/Provider Correspondence Horizon NJ TotalCare Misc Member/Provider Correspondence PO Box 24081 Newark, NJ  07101-0406 Provider Services (available 8am to 6pm ET, M-F) 1 (855) 955-5590 Member Services (Non-MLTSS) (available 24/7) 1 (800) 543-5656 Member Services (MLTSS) 1 (855) 355-5599 Mailing Address for Paper Claims Horizon NJ TotalCare Claims Processing Department PO Box 24080 Newark, NJ  07101-0406 Participating providers for payment disputes must use Member Provider correspondence

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 Submitting Claims with Taxonomy Codes:   Institutional Claims: For paper UB04 institutional claims, the taxonomy code should be placed in box 81 and should be submitted with the “B3” qualifier. UB-04 Paper Institutional Claim Form (for enumerated providers) Billing Provider Taxonomy Code Locator 81 Professional Claims: For paper CMS-1500 professional claims, the taxonomy code should be identified with the qualifier “ZZ” in the shaded portion of box 24i. The taxonomy code should be placed in the shaded portion of box 24j for the rendering level and in box 33b preceded with the “ZZ” qualifier for the billing level. CMS 1500 (02/12) Professional Claim Form (for enumerated providers) Please be sure that your claim software supports the revised 1500 claim form (02/12). Reference the 1500 Reference Instruction Service Facility Location NPI Field 32a. You can reference the 1500 Reference Instruction Manual at nucc.org for specific details on completing this form.  Additional claim submission guidance is available in Section 9 of the Physician and Health Care Professional Manual, located at horizonNJhealth.com. Electronic Claims: Taxonomy codes on electronic claim submissions with the ASC X12N 837P and 837I format are placed in segment PRV03 and loop 2000A for the billing level and segment PRV03 and loop 2420A for the rendering level.

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

(Physician Administered Drugs - UMO) 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)

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

Horizon NJ Health does not accept handwritten or black & white claims Billing: Paper Claims Horizon NJ Health does not accept handwritten or black & white claims REJECT APPROVE 123 MAIN ST. Can not be handwritten or altered in any way (this includes stamps)

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

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

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

Q & A