Claims
Timely Filing for Claims (original, corrected, TPL)
What is 180 days from DOS for original submission.
What is 365 days from DOS for corrected claims.
What is 60 days from the date of EOB for TPL claims.
This application houses ALL referrals and authorizations.
What is Prospective UM.
This vendor will handle our transportation requests.
What is Logisticare.
This section educates the provider that an EOB from primary insurance will be needed and if primary denies, we will need an auth.
What is section 9.6.2 Other Third party medical insurance.
Using claims inquiry, what is the paid date on claim id 19316G055300
What is 12/11/2019 originally, and adjusted final on 4/15/20.
Provider has 90 days from DOS to submit this.
What is a Claim Appeal
Non Urgent authorization processing time frame.
What is 7-14 days.
This vendor will handle our pathology testing.
What is LabCorp.
This sections discuses what a member/provider can do if they receive a denial by UM.
What is section 10.2 UM Appeals Process
Using claims inquiry, did the following claim deny correctly? 20160G217900
What is, yes, provider submitted a corrected claim and did not include the original claim id. (datanet))
Claims Processing Address
What is Horizon NJ Health Claims Processing Department PO Box 24078 Newark, NJ 07101-0406
The authorization number starts with 000
What is a CareRadius Authorization Number.
This vendor will handle our Radiology Benefits
What is EVICORE
This sections discusses the CPT codes for vaccinations.
What is section 13.13 VFC Immunizations
Using facets, for claim id 20199H415100, what is the servicing providers Agreement ID for Network ID 0700HM000001 with term date Aug. 31.
What is 700PCPFS0001
Claims that are hand written, marked, or not on red and white copies will only generate a DCN.
What is a Front End Rejection.
This benefit will typically flag for an authorization even if its from an ER visit.
What is an Inpatient Stay.
This is NOT a part of Substance Use Disorder Benefit.
What is Tobacco Cessation.
This sections discusses the following: Social work, Home care, Private duty nursing, etc
What is section 3.11 Home Health Care.
Using facets, what claim ID is associated with the following reference number 082120001671
What is, there is no claim on file in facets.
Horizon Payor ID.
What is 22326
One time authorization for OON is also known as:
What is a single case agreement.
Limit to 2 inserts and 1 pair of shoes.
What is Orthotics and Prosthetics.
This section discusses FFS for behavioral health.
What is section 3.17 Behavioral Health Services (including mental health and substance use disorder treatment)
Using claims inquiry, 20163G0175, what is the status of the claim and what do you respond to your provider if they do not agree?
What is the claim has denied for Cotiviti Review, the service code is inconsistent with modifier used. If you do not agree you are more than welcome to appeal this claim or submit a reconsideration request on Navinet.