Transcript Health Plans and Health Literacy

www.horizonNJhealth.com
Horizon NJ Health
Horizon NJ Health Presentation For
Home Care Association of New Jersey
April 24, 2015
Topaz Webb
MLTSS Network Relations Specialist
MLTSS Network Relations
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Horizon NJ Health
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
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Horizon NJ Health
Prior Authorization
 Authorizations created when care plan is agreed upon
 Servicing provider is identified and confirmed
 Authorization letter is faxed to provider
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Horizon NJ Health
Claims Submission
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Home Based Supportive Care
• Bill with HIPAA compliant codes:
• S5130 (modifier , if applicable)
MLTSS PDN
• Bill with HIPAA compliant codes:
• 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 7117
London, KY 40742
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Horizon NJ Health
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
www.emdeon.com/eftsignup or contact Emdeon at
1-877-461-9605
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Horizon NJ Health
How to Check Claim Status
 Call Provider Services Hotline: 1-855-777-0123
 Access claims status online through NaviNet.net
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Horizon NJ Health
Claim Appeals
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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:
http://horizonnjhealth.com/sites/default/files/HCAPP_Appeal_Form
_0.pdf
Claim appeals may be submitted via mail within 90 days of denial
by:
• Mail: Horizon NJ Health
Claim Appeals
P.O. Box 63000
Newark, NJ 07101-8064
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Horizon NJ Health
Critical Incident Reporting
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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.
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Call
– MLTSS Member Services: 1-844-444-4410
OR
– MLTSS Provider Services: 1-855-777-0123
Mail Report to:
Horizon NJ Health
Attention: Quality Department,
MLTSS Complaints Unit
210 Silvia Street
West Trenton, NJ 08628
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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
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Horizon NJ Health
Provider Demographic Changes
 Request to Change Information Form
• By Fax: 609-583-3004
• 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
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Horizon NJ Health
Provider Resources
 www.horizonnjhealth.com/provider
• Provider Services: 1-800-682-9094
• MLTSS Claims Inquiries: 1-855-777-0123
 https://office.emdeon.com/vendorfiles/amerihealth.html
• Emdeon Customer Care: 1-888-363-3361
 www.navinet.net
• NaviNet Customer Care: 1-888-482-8057
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Horizon NJ Health
Contact Us
Dedicated Provider Relations Staff
Amy Durkin
MLTSS Provider Relations Coordinator
[email protected]
Topaz Webb
MLTSS Provider Relations Specialist
[email protected]
Marsha A. Gittens-Lee
Manager, MLTSS Network Relations
[email protected]
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Horizon NJ Health
Questions?
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