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Horizon BCBS NJAll Plans · Administrative · Claims & BillingHigh impact

Prevent Incorrect Reimbursement to Individual Practitioner on Group Practice Claims

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

Summary

Horizon Blue has issued an urgent policy to prevent claims from being routed to individual practitioners instead of group practices. When submitting 837P claims for a group practice, billing teams must use the group's Tax Identification Number (TIN) and group Type 2 NPI in Loop 2010AA, not the individual practitioner's Type 1 NPI. Incorrect formatting is causing reimbursement errors and payment delays.

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What to do

immediately · 4 steps
01Billing team must audit all active 837P claim submission templates and verify that group practice claims use ONLY the group's TIN and group Type 2 NPI in Billing Loop 2010AA (NM102=2, NM109=Group NPI, REF01=EI, REF02=Group TIN).
02Do NOT include individual practitioner Type 1 NPIs in the group billing loop.
03Coordinate with practice management system vendor, clearinghouse, and IT department to update system rules and validation logic.
04Claims submitted with practitioner Type 1 NPIs linked to individual Social Security numbers will process incorrectly and route reimbursement to the wrong payee, causing payment failures and requiring resubmission.

Original notice

Prevent Incorrect Reimbursement to Individual Practitioner on Group Practice Claims
horizonblue.com · Always check the source before changing claims.
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