Medical Policy for Foot Care Services Is About to Change 

Based on the revised medical policy for Foot Care Services, Horizon is about to bring some changes in terms of professional claims. These changes will be effective from December 5, 2022.  

Claims submitted (on or after December 5, 2022) for patients who are enrolled in Horizon commercial plans and ASO employer group plans will be processed differently which is enumerated below.  

Additional information may be requested to determine the medical appropriateness of the services represented by procedure codes 11055, 11719, and S0390.  

Horizon will also decrease the number of submitted diagnosis codes that will generate a request for additional information. This will help them to determine the medical appropriateness of services represented by procedure codes 11720 and 11721.  

Source: https://www.horizonblue.com/providers

Reimbursement Policy Updates Regarding Facility Documentation Requests 

Starting from November 14, 2022, facilities that are part of the Horizon BCBSNJ will have 25 days to respond to any documentation requests from Horizon as a part of the pre-payment or post-payment audit or review process.