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

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

3. 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 , option 1 for more information
or visit the Horizon NJ Heath online to sign up Or
Link for form:

4. 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

5. Provider Demographic Updates

6. Provider Demographic Updates

7. 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

8. NDC Billing
Physician Administered Drugs (UOM)

9. NDC Billing
Fill in NDC & Date of Service

10. NDC Billing
RESULTS
Use Correct Unit Of Measure when Billing

11. 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:

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

13. Claims Status on Navinet
Complete Fields With *
Provider
Service Date

14. Self Service Tools
Please refer to our website 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: inquiry directly to credentialing at . Allow 48hours for a response
Provider Service:

15. Q & A