Important Updates to Electronic Remittance Advice (ERA) Availability (2024)

Beginning May 20, 2024, Electronic Remittance Advice (ERA) transactions will be available for Horizon NJ Health providers. All providers must register to receive ERA 835 transactions. This includes providers in both Medicaid and Horizon NJ TotalCare (HMO D-SNP) lines of business.

How to register to receive ERA 835 transactions

Submit a completed Electronic Remittance Advice (835) Enrollment Form. A completed enrollment form is required for each tax identification/NPI combination. Leave the “Other Identifier” section of the form blank, as Provider Payee ID is not required.
You will receive a confirmation email once the Electronic Remittance Advice (835) Enrollment Form is processed.

In addition to receiving newly processed ERA 835 transactions on and after May 20, 2024, providers will also receive past ERA 835 transactions dated from February 20, 2024 through May 17, 2024.

All clearinghouses also must register through this tool to receive ERA 835 transactions. Horizon has communicated to all clearinghouses regarding this required registration, however, we encourage providers to confirm that their clearinghouses have registered to receive ERA 835 transactions.

If providers have any questions related to the ERA enrollment, they can call the EDI service desk at 1-888-334-9242 or email HorizonNJHealth_EDI@HorizonBlue.com

Change Healthcare Clarification

We want to clarify a recent communication from Optum Health, which previously acquired Change Healthcare, related to an “Active Payer List.” Despite the information contained in this communication, please know that Horizon has not reconnected to Change Health, as most of their systems remain unavailable. Horizon is working with Optum to test their temporary iEDI solution but is not connected to this solution at this time.

Please be advised that Horizon is not receiving any electronic claims submissions through Optum or Change Healthcare. As previously communicated, Horizon can receive claims directly through Availity Essentials or these alternate clearinghouses.

We apologize for any inconvenience and are committed to working with our providers as Change Healthcare continues to work to restore their operations. We will continue to keep you updated with accurate and timely information about the specific systems that Horizon reconnects to as this situation continues to evolve.

EOP statements are now available on Availity Essentials

As you know, payments for Horizon NJ Health and Horizon NJ TotalCare (HMO D-SNP) claims have been impacted by the Change Healthcare cyber security issue.

As an interim process, Horizon worked with our banking partner to issue payments directly to our providers. The payments do not have the corresponding EOP statements, ERAs, and/or 835 files.

Providers can get payment details for these checks from Horizon NJ Health when signed in to Availity Essentials. Once signed into Availity Essentials, follow these steps.

In the navigation bar, select Payer Spaces, and then select Horizon NJ Health
On the Applications tab, select Report Inquiry
Fill in the required information and select Explanation of Payment (EOP) from the Administrative drop-down menu
Enter a Claim ID or Check #
Once the Search button turns green, click Search

Providers registered for EFT/ACH payments will continue to receive their payments in that manner. Providers not registered for this form of electronic payment will continue to receive paper checks. The claim information for EFT payments will be available in Availity Essentials by the end of March.

Availity Essentials is a product of Availity, LLC. Availity, LLC has contracted with Horizon Blue Cross Blue Shield of New Jersey and its affiliates for the administration of the provider portal. Availity, LLC is independent from and not affiliated with Horizon Blue Cross Blue Shield of New Jersey.

Claims Payment

As you know, Change Healthcare experienced a cyberattack on February 21, 2024. As a result, the business operations of many companies nationwide, including Horizon, have been impacted. For the security of all impacted by this attack, our systems were disconnected from Change Healthcare. For that reason, claims that were submitted through Change Healthcare on or after the attack cannot be accessed and processed.

Providers can resubmit these claims via NaviNet to Horizon for immediate processing. There are also alternate clearinghouses Horizon provided previously (listed below) that you can use to submit your claims.

We apologize for any inconvenience and are committed to working with our providers as Change Healthcare continues to work to restore their operations.

Updates from Change Healthcare can be found here: Information on the Change Healthcare Cyber Response - UnitedHealth Group.

Alternate Clearinghouses – Please contact them directly for help with claims submission

Ability Network

1-973-796-1521

www.abilitynetwork.com

Availity LLC

1-800-282-4548

Payments Impacted by Change Healthcare Issue

Payments for Horizon NJ Health and Horizon NJ TotalCare (HMO D-SNP) claims have been impacted by the recent Change Healthcare cyber security issue. Change Healthcare is a vendor that supports Horizon with the issuance of claim payments, Explanation of Payments (EOPs), Electronic Remittance Advices (ERA) and EDI 835 files to providers for these products.

As an interim process, Horizon has worked with our banking partner to begin issuing these payments directly to our providers, bypassing the Change Healthcare process. The immediate impact to providers is that payments will be received without the corresponding EOPs, ERAs and/or 835 files. We made this decision to minimize the financial impact to our provider partners in the short term. Providers can continue to view the claim payment details in the portal through NaviNet and Availity Essentials. When Change Healthcare's systems are back on line, the corresponding EOPs, ERAs and 835 files will be issued and will align with the corresponding check number received.

Providers registered for EFT/ACH payments will continue to receive their payments in that manner. Providers not registered for this form of electronic payment, will continue to receive paper checks.

Provider Claims Submissions Update Due to Change Healthcare Issue

As you know, Change Healthcare has been significantly impacted by a cyber

security issue, which is also affecting the business operations of many companies nationwide, including Horizon. This is not a Horizon incident, and at this time, there is no indication that our systems have been compromised. Once we became aware of the incident, we disconnected our systems from Change Healthcare and are reviewing the impact to our business operations.

One key impact is related to provider claim submissions that have been disrupted by the Change Healthcare incident. Should you decide to change your EDI claim submission from Change Healthcare, Horizon can accept EDI claims from the following clearinghouses:

Ability Network

1-973-796-1521

www.abilitynetwork.com

Availity LLC

1-800-282-4548

enrollments@availity.com

CLAIMMD

1-855-757-6060

support@claimmd.com

CUREMD

1-212-852-0279

enrollment@curemd.com

EProvider Solutions

support@eprovidersolutions.com

Experian

1-224-698-5600

experian.com/healthcare/

Healthcare IP

payers@healthcareip.com

Office Ally

1-360-975-7000

support@officeally.com

Practice Insight

enrollment@practiceinsight.net

Zirmed

ENROLLMENT@ZIRMED.com

Please contact these clearinghouses directly for more information.

We know the Change Healthcare cyber security incident has created disruption across the health care environment and we remain committed to working with our provider partners to ensure that our members haven access to the care they need.

Information about Change Healthcare's Security Incident

We are aware that Change Healthcare, a vendor that connects payers, providers and patients within the U.S health care system, is experiencing a cyber security issue that is affecting the business operations of many companies nationwide, including Horizon. This is not a Horizon incident, and at this time, there is no indication that our systems have been compromised. Once we became aware of the incident, we disconnected our systems from Change Healthcare and are reviewing the impact to our business operations.

We are aware that some of our providers and members have been impacted by this incident. If during this time, your patients need help filling a prescription, please have them call:

Commercial members - 1-800-370-5088

Braven Health members - 1-855-457-0222 (TTY 711)

Medicaid members - 1-800-682-9094, ext 81016

DSNP members - 1-855-457-1346 (TTY 711)

If your EDI clearing house is impacted, please check with them for further instructions.

We know this can be concerning and are working hard to make sure your patients have continued access to care. We are gathering more information as the situation unfolds, assessing all options, and will provide updates early next week.

Published on: May 7, 2024, 13:29 PM ET

Last updated on: May 9, 2024, 08:20 AM ET