Payment Summaries and Vouchers

NASCO PAYMENT SUMMARY

We use the NASCO® Processing System (NPS) to adjudicate claims for customers enrolled in Horizon POS, FEP, Medigap plans, large national accounts and claims for customers enrolled in an out-of-state Blue Cross and/or Blue Shield Plan.

Information about claims processed on the NPS is communicated to you on a NASCO Payment Summary.

For information about the NPS or the NASCO Payment Summary, please call the Physician Services number indicated on the patient's member ID card.

EXPLANATION OF PAYMENT

Horizon's Explanation of Payment helps you obtain the information you need quickly and easily in a simple-to-read format. It includes summary sections, a message center and the following:

• A cover page that includes payment summary information.
• Bolding of patient names to differentiate the patient from the subscriber.
• A layout that simplifies navigation of the voucher.
• Remark and reason code messages below the patient claim detail explaining any payments/nonpayments.

If you have questions, please call Provider Services at 1-800-624-1110.

Payment Summary

This is a summary of the gross claim amount, late interest, account receivables (A/R) applied and the check amount. The check amount is the actual payment after consideration of the late interest and A/Rs applied.

Claim Detail

This section lists all claims sorted by product and patient. Claim detail includes remark and reason code messages directly below the patient claim detail providing further explanation. We provide detailed information regarding claims denials. For example, enhanced messages provide specific details about claims processed against an authorization where one or more of the following have been exceeded:

• Days
• Hours
• Services
• Units
• Visits

The message will contain both the quantity authorized and also the units of measure of that quantity.

Account Receivable Summary

This section highlights all outstanding payments due to Horizon, detailing the patients' claim where the A/R was initiated and indicating any monies deducted from your reimbursement to satisfy the A/R. We have limited the number of times a single A/R will appear in the account receivable summary section of subsequent paper and online UPS vouchers. An A/R will only appear in the account receivable summary section when:

• The A/R is initiated.
• Monies are received from a physician and applied toward that A/R.
• The A/R is activated (45 days after an A/R is initiated if monies have not already been received to satisfy it).
• Claim reimbursements are applied toward the active A/R.
• The A/R is completely satisfied.

Late Interest Summary

This area details the claims that require Horizon BCBSNJ to pay a late interest payment. The late interest payment will be added to the claim payment on this form.

BILLING HORIZON MYWAY PATIENTS

Horizon MyWay Visa®/Debit card

You should wait until you receive an Explanation of Payment (EOP) from Horizon BCBSNJ before billing patients for coinsurance and deductibles, since you may not know the correct amount to collect at the point of service. Your contract prohibits you from balance billing members.

Special Payment Options

To simplify payment to you, Horizon MyWay members with an HSA, HRA or FSA may have a Horizon MyWay Visa/debit card and/or personalized checks to pay for medical expenses not covered under their health plan. These will process like regular debit cards and checks.

Members can use the Visa/debit card or checkbook to pay copayments and other eligible medical expenses.

Members without a card can pay online or through the Horizon MyWay mobile app, which offers a range of tools to helps them manage their health spending and supplemental accounts.

HORIZON MYWAY HRA EXPLANATION OF PAYMENT

You may receive an additional ROP for Horizon MyWay HRA patients. This is in addition to the initial Horizon EOP advising you of available funds in the member's HRA. This explanation may include payment from that account and an explanation of the final member liability.