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Feature Stories Highlight Physician Collaborations and Innovations
Horizon BCBS NJ·Provider News
Effective date
Sep 1, 2022
We identified it
Jun 26, 2026
Summary
This is a Horizon Blue provider news bulletin from September 2022 featuring multiple updates including new authorization features in their eligibility tools, guidance on diagnosis coding specificity, and Trinitas Regional Medical Center's designation as an OMNIA Tier 1 hospital. Key actionable items include utilizing the new Authorizations feature in the Member Eligibility and Benefits Cost Share Estimator, submitting specific diagnosis codes to prevent denials, and updating facility networks for Trinitas.
Action Required
By September 30, 2022: (1) Billing team must access and familiarize staff with the new Authorizations feature added to Horizon Blue's Member Eligibility and Benefits Cost Share Estimator tool—train front-desk and verification staff on how to run authorizations through this updated portal. (2) Providers and coders must implement practice-wide protocol to submit the most specific diagnosis codes available on all claims to avoid claim line denials; update coding guidelines and auditing procedures to catch non-specific codes before submission. (3) Update facility credentialing and referral lists to recognize Trinitas Regional Medical Center as an OMNIA Tier 1 hospital; communicate network status change to providers who make referrals. (4) Notify Horizon Blue immediately if your practice has made any changes to your practice data (address, NPI, tax ID, ownership, etc.) per their requirement. Failure to use specific diagnosis codes will result in increased claim denials.