Why do you pend an entire claim when there is a problem with only one item?
A7. For audit purposes, Horizon BCBSNJ must either accept or reject a claim as originally submitted. Additionally, one item can impact the payment of the entire claim. For example, when a claim is submitted for surgery, and the physician or other health care professional bills with an invalid surgical procedure code and there are multiple surgical procedure codes listed on the claim, the invalid procedure code may impact payment. Therefore, the entire claim has to be pended in order to process it correctly.
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