Start free

PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
Horizon BCBS NJAll Plans · Documentation · Provider News · NJ · Pediatrics, Psychiatry, Family Medicine +1 moreHigh impact

Include Attending Provider Details on Claims for Members Prescribed ADHD Medications

Act
immediately
Effective date
Not stated in the notice
Identified
Oct 3, 2026

Summary

Horizon Blue now requires that all facility claims for children ages 6-12 diagnosed with ADHD and prescribed ADHD medication must include attending provider details (first name, last name, and NPI with appropriate taxonomy code) to ensure proper recognition and compliance with HEDIS ADD-E quality measures. This applies to both the Initiation Phase (30-day follow-up) and Continuation & Maintenance Phase (270-day follow-up period) of care tracking.

Get alerts when payers change rules like this one

We check Horizon BCBS NJ and other payers every day and email you when a change matches your specialty and state.

Get Horizon BCBS NJ alertsPolicy Monitoring is free. No card required.

What to do

immediately · 7 steps
01Billing team must update all claim submission processes to capture and include attending provider first name, last name, and NPI on facility claims for pediatric ADHD patients ages 6-12.
02For 837I electronic claims, ensure attending provider details are populated in Loop 2310A (NM1 segment with NM101='71', NM102='1', NM103=Last Name, NM104=First Name, NM109=NPI) and Segment PRV (PRV01='AT', PRV02='PXC', PRV03=Taxonomy Code).
03For UB04 hard-copy submissions, ensure attending provider details (last name, first name, NPI) are included in field 76.
04Update encounter forms, EMR templates, and billing system validation rules to require this information before claim submission.
05Update staff training to identify ADHD diagnoses and medication prescriptions for children ages 6-12.
06Claims submitted without complete attending provider details will not be recognized for HEDIS compliance measurement.
07Contact your Provider Account Specialist or email BH_HEDISTeam@HorizonBlue.com with questions.

Original notice

Include Attending Provider Details on Claims for Members Prescribed ADHD Medications
horizonblue.com · Always check the source before changing claims.
View original ↗

Related policy hubs

Horizon BCBS NJ policiesNJ policy changesPediatricsPsychiatryFamily MedicineInternal Medicine

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Policy MonitoringPayer policy, prior auth and coding changes, filtered to your saved searchesOIG ScreeningStaff and vendors screened every month against OIG LEIE, SAM.gov and state Medicaid listsPrior Auth LookupKnow if a service needs prior authorization before you schedule itCredentialing TrackerLicenses, CAQH, Medicare revalidation and payer enrollments, with reminders before anything lapsesCompliance CenterKeep your HIPAA program documented and ready to show
Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account