Visit our Availity page to learn what tasks you can accomplish using Availity, how to register, and where to find training materials. The American Dental Association (ADA) has published a table with commonly reported CDT Codes with examples of possible ICD-10 diagnostic codes. Site Map These set the maximum allowable fee you can bill a patient for covered services and the maximum payable by their plan. Training is free online and available at your conveniencethere's no need to schedule! The American Dental Association (ADA) has published a table with. FEP Blue Dental Brochure - Blue Cross Blue Shield FEP Dental - Home Here is everything you need to know about dental fee schedules, and if you are interested in improving your practices ability to manage dental insurance, see how Weave can simplify insurance verification. H\@E|E/g#lj,!K~H^8 m)>}D By participating in the Blue Cross and Blue Shield of North Carolina (Blue Cross NC) plan, you now have access to BCBS FEP Dental members. These amounts arent always the same: The insurer may have set a lower fee than your actual charge. 0000026292 00000 n Payment is not guaranteed. The Blue Cross and Blue Shield name and symbols are registered marks of the Blue Cross Blue Shield Association. trailer <]/Prev 370171/XRefStm 1510>> startxref 0 %%EOF 295 0 obj <>stream 0000021616 00000 n 0000006823 00000 n 2023 Blue Cross and Blue Shield of North Carolina. Proudly supporting more than6,600 member dentistsnationwide, and caring for around1.4 million patientsacross the UK. GRID Dental Corporation is a separate company that provides access to dental networks and services on behalf of Blue Cross NC. Our Dental Provider Savings Program offers network providers discounts of up to 40% on in-demand products (PPE equipment, scanners), lab services (implants, clear aligners, dentures), and turnkey teledentistry solutions for your office. Valid NPI and Captcha are required to proceed. You can view your patients'health records, including prescriptions, ER visits, lab results, and care alerts if your patient has a chronic condition. This broad category includes anything from minor procedures like fillings to big interventions such as final restoration after root canal treatment, crown and tooth implants, and oral surgery. If you already have one of our other plans, you can add Denplan Supplementary Insurance to your plan to give you similar cover. Once you sign your in-network contract and become a participating provider, you must charge insured patients according to the insurers dental fee schedule. On Feb 6, 2023, Rep. Steve Cohen introduced the Medicare Medically Necessary Dental Care Act; a bill that could expand coverage for Medicare beneficiaries on dental treatments and procedures considered medically necessary. You currently have JavaScript disabled in your web browser, please enable JavaScript to view our website as intended. The members card will be identified with BCBS FEP Dental at the top of the ID card, along with theclaimssubmission address and customer service number on the back to verify benefits. However, working with insurers can increase your exposure and expand your client base, with the increased turnover making up for the lower fees. For more than 20 years, we have been dedicated to delivering on our mission of improving the quality, cost effectiveness and accessibility of dental care for our customers. Usage Agreement 0000023675 00000 n 0000039502 00000 n One of these networks is DeCare Dental Networks' National Network, a national fee-for-service . Compare costs for out-of-network dentists with network dentists and see how much you can save. Training is free online and available at your convenience . 147 43 For help accessing an NHS dentist in an emergency or out of hours, visit: Your NHS dentist will provide any clinically necessary treatment needed to keep your mouth, teeth, and gums healthy and free of pain. 0000025684 00000 n This is more true now than ever before, as a recent bill could offer Medicare recipients extended coverage for dental procedures considered medically necessary. You would be responsible for any amounts over the maximum charge aswell any co-insurance. If the fee schedule allows for a maximum charge of $1,000, patients may pay anywhere between $0 and $500 out . We offer a variety of dental payment plans to help you budget for your personal dental care. Electronic Data Interchange (EDI) Services, National Provider Identifier (NPI) Registration. with examples of possible ICD-10 diagnostic codes. Understanding these types of changes and adjusting your practices fee schedules to accommodate new Medicare coverage could set your dental office apart from others in your area. Information about dental costs and how to get help with paying for dental care. DenteMax is committed to delivering quality service and support to its dentists, client partners and their members. 0000043219 00000 n Dentist's fee is $185 PPO in-network Blue Par Select Out-of-network; Your cost: $61: $88.50: $96.50: Blue Dental EPO Plans. network and you'll be reimbursed based on the lower of your dentist's fees, or the maximum allowable charge, which is the amount that would be paid to dentists who have agreed to be reimbursed according to a negotiated fee schedule. a resource to help you navigate the GRID program, Click here for an in-depth look at FEP BlueDental benefits, Surprise Billing - Out-Of-Network Provider Notice. 0000042153 00000 n A dental fee schedule is a list of prices for specific treatments and services that insurers pay dentists, other providers, and suppliers. However, working with insurers can increase your exposure and expand your client base, with the increased turnover making up for the lower fees. Privacy Policy Important notice: Provider EFT Enrollments Federal Mandate and Other Enhancements, Dental Appointment Availability Standards, Third Party Administrators, Other Payors and our Affiliates, Augmented Intelligence Dental Claims Processing. The national Dental GRID links the dental networks of participating BlueCross BlueShield plans and works from two networks (GRID and GRID+). Save 25% at specialists such as Endodontist, Orthodontist, Periodontists, Oral Surgeons and other specialists. 0000003328 00000 n Annual maximum. Some services will require prior authorization. is our all-in-one payment processing solution for dental offices, mental and behavioral health practices, and medical services. BCBS FEP Dental is responsible for the selection of in-network providers in your area. Please note:none of the following plans cover laboratory fees (to build crowns etc. Forgot Password? We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Dentists may also offer discounts on routine and restorative treatments as part of this plan. Find out how to get Denplan through your employer, and log in to your employee patient portal. For members with Empiredental benefits and an affiliated medical plan, you can: Check the Communications section regularly for ongoing communications to our participating dental providers. Our free webinars give you easy access to the latest industry thinking and practical support. hbba`b``3 @ endstream endobj 252 0 obj <>/Metadata 16 0 R/Pages 15 0 R/StructTreeRoot 18 0 R/Type/Catalog/ViewerPreferences<>>> endobj 253 0 obj >/PageWidthList<0 612.0>>>>>>/Resources<>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/StructParents 0/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 254 0 obj <> endobj 255 0 obj <> endobj 256 0 obj <> endobj 257 0 obj <> endobj 258 0 obj <>stream Looking for a Network Dentist? 0000000016 00000 n Maintaining up-to-date fee schedules should be a priority in your practice. Some carriers now also cover certain. The list is far from exhaustive, and a complex treatment plan may require multiple diagnoses and more than one procedure code. $1,500 (Employer-sponsored or Voluntary) or $2,000 (Employer-sponsored) Does not apply to Preventive & Diagnostic or Orthodontic Services. Not a member? Patient-facing fee schedules also include how much you charge for a service, such as crown installation or wisdom tooth surgical removal, and what the patients dental plan will cover. Dental insurance covers these in part only (usually, 80% for basic and 50% for major treatments. Have you used our online dental claims, eligibility, and benefits website? 0000014184 00000 n If the fee schedule allows for a maximum charge of $1,000, patients may pay anywhere between $0 and $500 out of pocket, depending on the treatment category. Not a network dentist? There are 3 NHS charge bands, the cost of each band is different in England and Wales. Plus, you can continue to bill non-insured patients your regular UCR fee. The benefits of private dentistry with Denplan, Only in case of dental injury or emergency. If you estimate incorrectly because you havent updated your fee schedule, you risk under-collecting. 0000005308 00000 n The Blue Cross Blue Shield Association (BCBSA), in partnership with the GRID Dental Corporation, administers FEP Dental. .H63vraI06I:[YcqVsylK\*00X(3"2 h\Ttfm p)G endstream endobj 188 0 obj <>/Filter/FlateDecode/Index[19 128]/Length 27/Size 147/Type/XRef/W[1 1 1]>>stream If you have an EPO plan, it only covers care you get from PPO in-network dentists. Payments for services from a non-participating provider are generally sent to the member, except where federal or state mandates apply, or negotiated agreements are in place. Designed to spread the cost of treatments, to make looking after dental health easy and affordable. As a North Carolina provider, regardless of whether the patient is a Blue Cross NC . vu6tWqL(|d> SI9N39y'#)[r+93@,sRguM-^0_lo1}7: o+ endstream endobj 259 0 obj <> endobj 260 0 obj <> endobj 261 0 obj <> endobj 262 0 obj <>stream 0000001510 00000 n 0000003870 00000 n NATIONAL GRID+ DENTAL NETWORK. CareFirst of Maryland, Inc. and The Dental Network, Inc. underwrite products in Maryland only. Choose your location to get started. 0000001691 00000 n The list is far from exhaustive, and a complex treatment plan may require multiple diagnoses and more than one procedure code. Discounts at the dentist. Verify patient eligibility and benefits, view member history of completed procedures, and more. There are 3 NHS charge bands, the cost of each band is different in England and Wales. Denplan 2023 0000057435 00000 n Choose your network below. If the member is covered under the Federal Employee Health Benefit Program (FEHBP), you may need to file with the FEP medical ID card first. The GRID networks are administered by GRID Dental Corporation for the exclusive use by Blue Cross and Blue Shield plan members nationwide. Alternatively, youd have to send a follow-up bill to collect the remainder, which could hurt your brand and undermine trust. The Horizon name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey. HWk\>?JC$&NhCezD]];w Serving Maryland, the District of Columbia and portions of Virginia, CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. CareFirst BlueCross BlueShield Medicare Advantage is the shared business name of CareFirst Advantage, Inc. and CareFirst Advantage DSNP, Inc. CareFirst BlueCross BlueShield Community Health Plan Maryland is the business name of CareFirst Community Partners, Inc. CareFirst BlueCross BlueShield Community Health Plan District of Columbia is the business name of Trusted Health Plan (District of Columbia), Inc. Power 2022 award information, visit jdpower.com/awards. Find out what the charge for each band: NHS dental charges in England April 24, 2021 If you're a participating provider with our Federal Employee Program (FEP) network, you're also an in-network provider for FEP Dental and GRID/GRID+. With the dental cost-of-care tool, you can check fees in your area for the service you want. If you pay NHS dental treatment charges then find out that youre entitled to free or reduced cost treatment, you can claim a refund. 0000050210 00000 n H\Pj0+tl{51akYpl%5,qC~S:@{1M5'Y+:S}#D%10)ri & _c}# g^iD?D &'dP (Co;k]'&-a Additionally, staying up-to-date with fee schedules can even attract new customers to your practice. DBA Anthem Blue Cross andBlue Shield, Anthem Health Plans of Virginia, Inc. DBA Anthem Blue Cross and Blue Shield, Anthem Health Plans, Inc. DBA Anthem Blue Cross and Blue Shield (CT), Anthem Insurance Companies, Inc. DBA Anthem Blue Cross and Blue Shield (IN), Blue Cross Blue Shield of Wisconsin DBA Anthem Blue Cross and Blue Shield, Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. DBA Anthem Blue Cross and BlueShield, Blue Cross of California DBA Anthem Blue Cross, Community Insurance Company DBA Anthem Blue Cross and Blue Shield (OH), CompcareHealthServicesInsuranceCorporationDBAAnthemBlueCross andBlueShield (WI), Empire HealthChoice Assurance, Inc. DBA Empire BlueCross BlueShield An Anthem Company or, Empire HealthChoice HMO, Inc. DBA Empire BlueCross BlueShield HMO or Empire BlueCross HMO (NY), Healthy Alliance Life Insurance Company DBA Anthem Blue Cross and Blue Shield (MO), HMO Missouri, Inc. DBA Anthem Blue Cross and Blue Shield, Matthew Thornton Health Plan, Inc. DBA Anthem Blue Cross and Blue Shield (NH), RightCHOICE Managed Care, Inc. DBA Anthem Blue Cross and Blue Shield (MO), RockyMountainHospitalandMedicalService,Inc.DBAAnthemBlueCross andBlueShield (COandNV), UniCareLife&HealthInsuranceCompanyDBAUniCareAnAnthemCompany. 0000039046 00000 n Dental Provider Resources | Anthem.com Find information that's tailored for you. Learn more about our non-discrimination policy and no-cost services available to you. All rights reserved. For more on how these features can support your practice, view medications, recent diagnoses, ER visits, or lab results that may affect your patients' dental health, confirm medical conditions that may display specific symptoms in the mouth, receive care alerts that notify you of any care gaps, or update your patients' medical condition, share patient vitals (like blood pressure, height, or weight), which can identify at-risk patients and reduce severity of systemic disease, Anthem Blue Cross Life and Health Insurance Company DBA Anthem Blue Cross (CA), Anthem Health Plans of Kentucky, Inc. DBA Anthem Blue Cross and Blue Shield, Anthem Health Plans of Maine, Inc. DBA Anthem Blue Cross and Blue Shield, Anthem Health Plans of New Hampshire,Inc. owned network. Providing patients with accurate pricing promotes transparency and trust and helps improve retention. AR PPP Specialist Fee Schedule 2023 Fill out the form below and we will have one of our support representatives contact you. Insurers often promote participating dentist offices to their policyholders. Important Notice: Provider EFT EnrollmentsFederal Mandate & Other Enhancements Below is a table explaining the benefits of our plans in more detail. February 10, 2021 Update: This communication has been updated with links to the 2021 Blue Cross Blue Shield FEP Dental Provider Implementation Guide and information about the GRID+ Dental Network. It looks like you're outside the United States. You may request the top 100 billed codes related to your specialty or the full fee schedule listing by checking one of the boxes below. 2 Save an average of 10-60% on most dental services including dental savings on: cleanings, X-rays, root canals, crowns, dentures, implants, braces and more! 0000019450 00000 n read or download our informational brochure. 0000029285 00000 n Additional details and links to exclusive discounts can be found in the brochure. 2023 Dental fee schedule. You can check eligibility and benefits, manage claims, view remittances and complete secured administrative tasks online. Find out how to apply for a refund of your NHS dental charges on help with dental costs. The implementation guide includes a claims submission checklist and other tips to ensure timely payment of submitted claims. %PDF-1.4 % 0000048184 00000 n www.bcbsfepdental.com To receive the most commonly billed procedure codes, fax a request on company letterhead to 410-872-4100 and include Provider ID, Tax ID, contact information and specific procedure codes if needed. 251 0 obj <> endobj xref National Dental GRID/GRID+ network participation will not change your reimbursement or participating provider agreement in any way. National Dental GRID Participating Plans and Networks January 1, 2019 This participating Plans or affiliated networks for the national Dental GRID (PPO) or GRID+ (Traditional) networks shown below may have one or more products using the Dental GRID. These reviews can be some of the best marketing for your business. Plan Feature. . 0000005420 00000 n Denplan for Children is a simple way of keeping up the great habit of regular visits to the dentist for your child, without you worrying about unexpected bills. You get one easy website for claims and attachments. The treatment category the procedure falls into, The average prices for dental services in the area. 6QQQQW((%%%%%#2"2"2".]]]]yWysP89o7o7o7KW/2K!cknne0i] atq_ 1d endstream endobj 263 0 obj <> endobj 264 0 obj <>stream It looks like you're in . Here are the instructions of how to enable JavaScript in your browser. Please contact us if you have questions related to your network status, if you need assistance using our online tools, or if you need help finding information. Exclusive Savings for Dental Network Providers Our Dental Provider Savings Program offers network providers discounts of up to 40% on in-demand products (PPE equipment, scanners), lab services (implants, clear aligners, dentures), and turnkey teledentistry solutions for your office. Get more: Something went wrong. Still, this resource can provide guidance on commonly occurring conditions, so you may wish to review these ADA codes often. Our resources vary by state. Dental benefit plans usually cover prevention in full and allow one or two procedures per year. 2023 Horizon Blue Cross Blue Shield of New Jersey, Three Penn Plaza East, Newark, New Jersey 07105. 0000007116 00000 n Though our website, network dentists and office staff members can access a variety of tools and resources needed to make delivering quality dental care to dental members easy and efficient. Coverage for some categories, such as crown installations, could be just 50%, while for others, it may reach 80% or even 100%. Please update your browser if the service fails to run our website. We currently don't offer resources in your area, but you can select an option below to see information for that state. hb``d``Abl,fT00L9Z6 Overcoming Patient Objections Concerning Urgency and Trust with Dr. Katz, Overcoming Patient Objections Concerning Cost, Time and Fear with Dr. Katz, A Simple Tactic to Increase New Patient Show Rates: A Personal Phone Call, Important Tip for Talking About Dental Fees and Payments Do it Early and Often, 1 Question to Ask Every New Patient During The First Phone Call Tips from Debra Engelhart Nash, 1 Simple Tip to Increase Patient Treatment Acceptance: Validate the Doctor, Average Medical Office Operating Expenses & How To Increase Your Profit Margin, Locum Tenens Dentists & Hygienists: Pros & Cons for Your Dental Practice, How Your Dental Practice Can Compete with Retail Teeth Whitening with Todd Snyder, 9 Strategies To Increase Healthcare Employee Retention at Your Practice, Daily Checklists for Your Veterinary Practice, Veterinary Benchmarks and KPIs You Need to Measure in Your Practice. All Rights Reserved. Weave Payments is our all-in-one payment processing solution for dental offices, mental and behavioral health practices, and medical services. One way to boost your income is to become an in-network provider and start billing patients per the insurers dental fee schedule. Find out who is entitled to free NHS dental treatment. Denplan Emergency offers you peace of mind in the event of a dental injury or dental emergency whether youre at home in the UK or abroad. 2023 PPO General Fee Schedule [pdf] 2023 PPO Specialist Fee . ). You can also visit bcbs.com to find resources for other states. The company oversees more than 20 dental networks in the United States and internationally. We hope you enjoy the content coming your way. FEPBlueDentalis now referred to as Blue Cross Blue Shield FEP Dental (BCBS FEP Dental). Your Type 1 NPI is required for access. If the plan cannot adequately answer questions about your contracted fee amount, please contact Blue Cross NCs Provider Service department at1-800-777-1643,Option 6. 0000020011 00000 n 2021 Blue Cross Blue Shield FEP Dental Provider Implementation Guide: Important Updates, Tips and Benefit Information, Health Plans for Individuals and Families, Get a Quote for Individual and Family Plans, Non-Discrimination Policy and Accessibility Services, 2021 Blue Cross Blue Shield FEP Dental Provider Implementation Guide. 0000032359 00000 n This plan will cover your regular check-ups and hygiene visits with your dental team, as well as any restorative treatment you may need. Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Find out what NHS dental treatment is available on NHS.UK. (Combined In-network/Out-of-network) In-network: $25/$75 Out-of-network: $50/$150. 0000015323 00000 n Please note that these forms are to be used by Federal Employee Program Members only, Important Update: Additional Policy Changes as PHE Ends, Referral Requirements for Services Not Related to COVID-19, Pre-Certification/Prior Authorization requirements for Post-Acute Facility Admissions, Telemedicine Cost Share Waiver for Non-COVID-19-Related Services to End, Telemedicine Cost Share Waiver for Non-COVID-19-Related Services to End for Self-Insured Health Plans, Submitting Pharmacy Claims for COVID-19 Vaccinations, Reminder: Select one method for COVID-19 and Influenza Testing, Antibody testing: FDA and CDC do not recommend use to determine immunity, June 2021 Updates: COVID-19 treatment cost share waiver, Reminder: Use correct codes when evaluating for COVID-19, 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 administration reimbursement at UCCs, COVID-19 vaccines will be covered at 100%, Reminder to use specific codes when evaluating for COVID-19, COVID-19 Update: Telemedicine Reimbursement Policy Addenda, Join a Horizon BCBSNJ or Horizon NJ Health Network (Physicians and Other Healthcare Professionals ), Join the Horizon BCBSNJ Network (Ancillary Providers), Join the Horizon NJ Health Network (Ancillary Providers), Blue Cross and Blue Shield of Minnesota: New PA requirement for Nusinersen (Spinraza), Blue Cross Blue Shield of Massachusetts: BCBSMA High Tech Radiology and Sleep UM Programs, Arkansas BlueCross BlueShield: AIM Medical Oncology Program to be Implemented for Tyson Foods Enrollees, Arkansas BlueCross BlueShield: Six specialty medications to need prior approval beginning April 2018, Blue Cross Blue Shield of Massachusetts: Radiology and Sleep Apnea Program Expansion, Blue Cross Blue Shield of Minnesota: Implementation of a Medical Drug Exclusions List, BlueCard Medical Policy/Pre-Certification Info, Braven Health Electronic Data Interchange (EDI), Horizon BCBSNJ Electronic Data Interchange (EDI), Cardiology Imaging Program Provider Questions and Answers, Medical Information Requirements for Programs Administered by eviCore, Medical Necessity Determination (MND) Review of Molecular and Genomic Diagnostic Testing Services Frequently Asked Questions, Molecular and Genomic Testing Procedure Codes, Musculoskeletal Program for Pain Management Services, Radiation Therapy Program Questions and Answers, Cardiology & Radiology Imaging Procedure Codes, Codes Considered Inclusive to an Imaging Service, Maternal Fetal Medicine Evaluation Coding, Radiology/Imaging Guidelines for Emergency Room Preliminary Reads (Wet Reads), Radiology/Imaging Program Guidelines for Use of Modifier 59, Correct Coding Rules Bank for Radiology, Cardiology and Ultrasound Services, Code Pairs Added to this List Effective January 1, 2023, Code Pairs Removed from this List Effective December 31, 2022, Code Bundling Rules for Radiology, Cardiology and Ultrasound Services, Prior Authorization/Pre-Service Registration, Medical Injectables Program Provider Questions and Answers, Specialty Pharmaceuticals for Office Administration, Braven Health℠ Medicare Advantage Plans, New Jersey Infection Prevention Partnership, Remote Patient Monitoring for COPD Provided by HGE Health, How Risk Adjustment Benefits You and Your Patients, Referral Process Using the Interactive Voice Response System, Effective use of the Interactive Voice Response System, Surgical and Implantable Device Management Program, About the Surgical and Implantable Device Management Program, Surgical and Implantable Device Management Program for Cardiac Surgeries Frequently Asked Questions Updated: March 25, 2021, Surgical and Implantable Device Management Program Orthopedic Services Frequently Asked Questions, Using Out-of-Network Providers in Surgical Services, Eligible Laboratory Procedures Rendered by a Practice, CMS Audits to Validate Directory Information, How to Make Demographic Updates: Participating Ancillary Providers, Horizon Data Submission Template for Ancillary Providers, Exceptions to Using Horizon Data Submission Template, Supporting Documentation Requirements for Practice-level Demographic Updates, Supporting Documentation Requirements for Practitioner Demographic Updates, Supporting Documentation for Ancillary Provider Demographic Updates, How to Make Demographic Updates: Participating Practices, Specific Criteria You Should Confirm is Accurate and Up to Date, Initiating Demographic Updates: Nonparticipating Providers, Time Limits for Filing Inquiries/Complaints, Appeals of Non-Utilization Management Determinations, Appeals of Utilization Management/Medical Management Determinations, Appeals of Post Service Medical Necessity Determinations, Allowable Practice Locations for Pathologists, Appointment Availability Access Standards for Primary Care-Type Providers, ObGyns, Specialists and Behavioral Health Providers, Credentialing and Recredentialing Policy for Ancillary and Managed Long Term Support Service (MLTSS) Providers, Credentialing and Recredentialing Policy for Participating Physicians and Healthcare Professionals, Diagnostic Imaging Privileging by Participating Provider Practice Specialty, EDI and NaviNet Claims Submission Requirement, Material Adverse Change (MAC) Notification Policy, Outlier Audit Programs: Post Payment and Pre-Payment, Physician and Healthcare Professional Counseling and Termination Policy - Professional Competency, Participation Status in Products that Utilize Tiering and/or Subset of an Existing Horizon Network, Practitioner Office Site Quality and Medical/Behavioral Health Record Keeping Standards, Provider Outlier Program Frequently Asked Questions, SHBP/SEHBP Inpatient Readmission Reimbursement, Standards for All Types of Medical and Dental Diagnostic Radiology and Imaging Facilities, Use of Horizon Hospital Network Performance Data, Add-on Payment for COVID-19 Diagnostic Testing Run on High Throughput Technology (U0005), Ambulatory Electrocardiographic Monitoring, Bariatric Surgery Billed With Hiatal Hernia Repair, Behavioral Health Services Rendered by Supervised Practitioners, Billing Guidelines for Maternity Services, Cardiovascular Implant Device Monitoring Services, Claims Requiring Additional Documentation, Continuous Positive Airway Pressure or Bi-level Positive airway Pressure (CPAP/BiPAP) Supplies, COVID-19 Testing and Testing Related Services, Daily Management of Epidural or Subarachnoid Continuous Drug Administration, Daily Maximum Units for Surgical Pathology and Microscopic Examination, Distinct Procedural Service Modifiers (59, XE, XP, XS, XU), Duplicate Claim Logic for Independent Laboratory Services, Evaluation and Management Services with Chiropractic Manipulative Treatment, Evaluation and Management Services with Osteopathic Manipulative Treatment, Evaluation and Management Services billed with Global Radiology, Stress Test, Stress Echo, Myocardial Profusion Imaging, Frequency of Care Coordination Services and ESRD Procedures, Horizon Fee Schedule Updates based on Third Party Sources, Hospital Non-Patient Laboratory Services Sample Fees, Laser Treatment of Psoriasis or Parapsoriasis, Medicare Advantage Hospital Sequestration Reimbursement, Mutually and Non-Mutually Exclusive NCCI Supplemental Edits, Outpatient Facility Code Edits: Bundling and Revenue Codes, Lab codes when billed with other services, Outpatient Laboratory Claims: Referring Practitioner Required, Outpatient Services Prior to Admission or Same-Day Surgery, Physician Extenders Non-Surgical Services, Pre-Payment Coding Reviews Documentation Requests, Pre-Payment Documentation Requests: Facility Claims, Post Payment Documentation Requests: Facility Claims, Pulmonary Diagnostic Procedures when billed with E&M Codes, Reimbursement and Billing Guidelines for Anesthesia Claims, Removal of Impacted Cerumen Requiring Instrumentation, Screening and Diagnostic Mammography & 3D Tomosynthesis, Telemedicine Services Reimbursement Policy: Temporary Addendum for Horizon BCBSNJ Commercial/ASO plans and products, Telemedicine Services Reimbursement Policy: Temporary Addendum for Horizon Medicare Advantage, Urinalysis with Evaluation and Management (E&M) Services, Prior Authorization Procedure Search Tool, Consumer Assessment of Healthcare Providers and Systems (CAHPS), Focusing on Your Horizon and Braven Health Patients Experience: Tools to Help You, Discussion Checklist for CAHPS and HOS Surveys, HEDIS Measure Guidelines for Behavioral Health Providers, Follow-Up Care for Children Prescribed ADHD Medication (ADD), Antidepressant Medication Management (AMM), Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM), Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (APP), Follow-Up After Emergency Department Visit for Substance Use (FUA), Follow-Up After Hospitalization for Mental Illness (FUH), Follow-Up After High-Intensity Care for Substance Use Disorder (FUI), Follow-Up After Emergency Department Visit for Mental Illness (FUM), Initiation and Engagement of Substance Use Disorder Dependence Treatment (IET), Adherence to Antipsychotic Medications for Individuals with Schizophrenia (SAA), Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications (SSD), Cardiovascular Monitoring for People with Cardiovascular Disease and Schizophrenia (SMC), Diabetes Monitoring for People with Diabetes and Schizophrenia (SMD), HEDIS Measurement Year (MY) 2023 Provider Tips for Optimizing HEDIS Results, Adherence to Antipsychotic Medications for Individuals With Schizophrenia (SAA), Adults Access to Preventive/Ambulatory Health Services (AAP), Antibiotic Utilization for Respiratory Conditions (AXR), Appropriate Testing for Children with Pharyngitis (CWP), Appropriate Treatment for Upper Respiratory Infection (URI), Avoidance of Antibiotic Treatment for Acute Bronchitis/ Bronchiolitis (AAB), Blood Pressure Control for Patients With Diabetes (BPD), Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia (SMC), Child and Adolescent Well-Care Visits (WCV), Childhood Immunization Status (CIS) (CIS-E), Colorectal Cancer Screening (COL) (COL-E), Deprescribing of Benzodiazepines in Older Adults (DBO), Depression Remission or Response for Adolescents and Adults (DRR-E), Depression Screening and Follow-Up for Adolescents and Adults (DSF-E), Diabetes Monitoring for People With Diabetes and Schizophrenia (SMD), Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications (SSD), Eye Exam for Patients With Diabetes (EED), Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence (FUA), Follow-Up After Emergency Department Visit for People With Multiple High-Risk Chronic Conditions (FMC), Follow-Up After High- Intensity Care for Substance Use Disorder (FUI), Follow-Up Care for Children Prescribed ADHD Medication (ADD-E), Hemoglobin A1c Control for Patients With Diabetes (HBD), Immunizations for Adolescents (IMA) (IMA-E), Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment (IET), Kidney Health Evaluation for Patients with Diabetes (KED), Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM-E), Osteoporosis Management in Women Who Had a Fracture (OMW), Osteoporosis Screening in Older Women (OSW), Persistence of Beta- Blocker Treatment After a Heart Attack (PBH), Pharmacotherapy Management of COPD Exacerbation (PCE), Postpartum Depression Screening and Follow-Up (PDS-E), Prenatal Depression Screening and Follow-Up (PND-E), Statin Therapy for Patients with Cardiovascular Disease (SPC), Statin Therapy for Patients with Diabetes (SPD), Unhealthy Alcohol Use Screening and Follow-Up (ASF-E), Use of Imaging Studies for Low Back Pain (LBP), Use of Opioids from Multiple Providers (UOP), Use of Spirometry Testing in the Assessment and Diagnosis of COPD (SPR), Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults (DMS-E), Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC), Well-Child Visits in the First 30 Months of Life (W30), Policies, Procedures and General Guidelines, Programs Administered by eviCore healthcare, Participating Physician and Other Health Care Professional Office Manual, Behavioral Health Network Specialist Assignments, Eligibility and Benefits Cost Share Estimator, Womens Health Results and Recognition Program, Provider Guidelines: Non-Standard (Medical Record) Supplemental Data for HEDIS Gap Closure, How to Submit Supplemental Data to Horizon, Health Outcomes Survey: How You Can Drive Results, Radiation Therapy Medical Necessity Determination, Pregnancy-Newborn Episodes of Care Program: Helping to Improve Outcomes for Moms and Newborns, As Mental Health Needs Continue To Rise, So Do Innovative Virtual Services, Treat Knee, Back, and Hip Pain with Orthotic Device that Helps Avoid Invasive Procedures, Horizon Neighbors in Health Program Supports Struggling Families, Bariatric Surgery Value-Based Program Helps Members with Weight Loss, Dental Providers Benefit from Dedicated Horizon Liaisons, Connecting with parents on the importance of early childhood health screenings and vaccinations, Episodes of Care Program Gives Cancer Patients the Care They Need, HealthSphere gives a behavioral health provider the full patient view, Home-Delivered Meals Help Braven Health℠ Patients, Horizon Neighbors in Health Program Helps At-Risk Members in Camden, How a value-based primary care provider helps the New Jersey Vaccination Program, Improving Health Equity through Increased Access to Prenatal Care Across New Jersey, Making Pathways in Innovating and Advancing Maternal Health, Pharmacy Collaboration leads to better patient outcomes and cost savings, Providing Innovative Cancer Care - Expanding Episodes of Care, Telehealth after COVID-19 Many doctors agree it's here to stay, Value-based care -- transforming health care with better collaboration and improved health outcomes, When planning, collaboration and crisis merge - a medical practice's successful response to COVID-19, Applicable Products:Commercial PPO/EPO &Exchange POS/EPO, Applicable Products: Commercial HMO & POS, Claims Payment Policies and Other Information.
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dental grid plus network fee schedule