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Horizon BCBS NJAll Plans · Documentation · Quality Measures · NJ · Psychiatry, Emergency Medicine, Critical Care +4 moreMedium impact

NCQA HEDIS Behavioral Health Follow-Up Measures:

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

Summary

Horizon Blue has issued NCQA HEDIS quality measure requirements for behavioral health follow-up care. Providers must ensure patients receive mental health or substance use follow-up appointments within 7 or 30 days after emergency department visits or inpatient/high-intensity admissions. This is a quality reporting measure that tracks follow-up compliance but does not change billing codes or reimbursement rates.

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What to do

immediately · 8 steps
01Providers and clinical staff must implement follow-up protocols to meet HEDIS measure thresholds.
02Establish appointment availability for mental health follow-ups within 7 and 30 days post-discharge.
03Implement outreach procedures to contact patients who miss appointments.
04Create documentation standards in EMR to capture follow-up visits with dates for the four measures (FUH, FUM, FUA, FUI).
05Coordinate with behavioral health treatment teams and discuss safety planning/crisis intervention during discharge planning.
06Educate patients on medication compliance and follow-up importance at discharge.
07Billing and quality teams should track compliance rates against HEDIS benchmarks.
08Contact Horizon's Behavioral Health HEDIS Team at BH_Hedisteam@horizonblue.com for technical assistance.
If missed: Failure to meet follow-up metrics may impact quality ratings and future reimbursement incentives.

Original notice

NCQA HEDIS Behavioral Health Follow-Up Measures:
horizonblue.com · Always check the source before changing claims.
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Related changes

See all Horizon BCBS NJ changes →
Helping Your Patients with Follow-Up Care for Mental Health or Substance Use Disorder (SUD)MediumNo effective date · Specialty ServicesFollow-Up Care for Individuals With Mental Illness or Substance Use DisorderMediumNo effective date · Provider NewsBrowse every Horizon BCBS NJ change in the policy list

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