Important Update: Horizon BCBS of NJ and Horizon NJ Health – Changes to ClaimsXten Editing Rules Policy for Evaluation and Management Services 

Horizon BCBS of NJ and Horizon NJ Health have announced a significant update to their ClaimsXten Editing Rules reimbursement policy. Effective October 1, 2023, certain professional claims will be reconsidered and reimbursed based on revisions to the “Evaluation & Management Edits (E&M)” subsection of the policy. 

This update specifically impacts the reimbursement of problem-oriented and routine/preventive Evaluation and Management (E&M) service procedure codes when submitted for the same date of service.