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Horizon BCBS NJMedicare Advantage · Reimbursement · Medical PolicyMedium impact

2026 Risk Adjustment Programs and Preventive Care Initiatives

Act
by Jan 1, 2026
Effective date
Jan 1, 2026
Identified
Oct 3, 2026

Summary

Horizon Blue has updated its 2026 Risk Adjustment Programs with new incentive structures for In-Office Assessments (IOAs), increasing maximum payment to $150 ($50 for IOA completion + $100 for Comprehensive Gap Assessment Program requirements), with full incentive available for assessments completed within 60 days and reduced payment ($135 maximum) for those completed after 60 days. The policy also emphasizes Annual Wellness Visits and In-Home Assessments as core preventive care initiatives.

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What to do

by Jan 1, 2026 · 7 steps
01Billing and clinical teams must update documentation and tracking systems to implement new IOA incentive structure.
02Configure billing system to track IOA completion dates and automatically apply $150 incentive for assessments completed within 60 days and $135 for those completed after 60 days.
03Update provider encounter templates to clearly document completion of In-Office Assessments and Comprehensive Gap Assessment Program (CGAP) requirements.
04Implement tracking mechanism to ensure providers document and address 100% of identified risk conditions to remain eligible for the $100 CGAP incentive.
05Train billing team and providers on new incentive payment structure and 60-day deadline.
06Establish calendar alerts for claims submitted after 60 days to apply reduced reimbursement rate.
07Contact RiskAdjustment@HorizonBlue.com for educational support on implementation.

Original notice

2026 Risk Adjustment Programs and Preventive Care Initiatives
horizonblue.com · Always check the source before changing claims.
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Related changes

See all Horizon BCBS NJ changes →
Helping Members Get Care: In-Home and In-Office Assessments to Close Care GapsMediumNo effective date · Provider NewsBrowse every Horizon BCBS NJ change in the policy list

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