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Wednesday, May 26, 2010

Physician information missing denial

Physician Name Missing or Invalid

The hospital, physician or health care professional’s name and Horizon NJ Health identification number for that hospital, physician or health care professional must be listed in the appropriate fields on the claim. The name listed must be the hospitals physician or health care professional that performed the service. The name and number must accurately represent the service practitioner or facility’s name and Tax Identification Number (TIN) and must exactly match the information documented in Horizon NJ Health’s records.
IMPORTANT – An individual physician’s or health care professional’s name is required on all claims whether submitted on paper or electronically. Claims without an individual physician’s or health care professional’s name in Box 31 of the CMS 1500 (HCFA 1500) claim form or Boxes 82 to 83 of the UB-04 claim form cannot be processed for payment.

IMPORTANT – The individual service practitioner’s name and number must be indicated on all claims for professional services, including outpatient clinic claims. Using only the group or billing entity name and number will not be
processed for payment by Horizon NJ Health.

Hospital, Physician or Health Care Professional Identification Number Missing or Invalid

All of the appropriate hospital, physician or health care professional identification numbers must be included on the claim. Those numbers include Horizon NJ Health’s assigned individual and group identification numbers and the TIN. Review the CMS 1500 (HCFA 1500) claim form and the
UB-04 claim form required fields documents in this manual for specific placement of these identification numbers. The HIPAA Implementation Guide for the 837 transaction will indicate where this information should be placed on electronic claims.

IMPORTANT – When the physician, facility or other health care professional has more than one Horizon NJ Health identification number, use the number that matches the services submitted on the claim. Imprecise use of
identification numbers may result in rejections, inaccurate payments or denials.

IMPORTANT – All the information submitted on the claim identifying the service practitioner must exactly match the information documented in Horizon NJ Health’s file. Failure to notify Horizon NJ Health of EIN, address or group affiliation changes can result in processing or payment errors.

Signature Missing

The signature of the provider of service must be present on the claim form and must match the service physician or health care professional name and EIN on file with Horizon NJ Health.

IMPORTANT – Claims without the physician or health care professional signature will be rejected. The physician or health care professional is responsible for re-submitting these claims within 180 calendar days from the date of service.

IMPORTANT – Signatures other than the physician’s or supplier’s are not valid for claims submitted to Horizon NJ Health and could cause payment delays, inaccuracies, rejections or denials

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