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Insurer Agrees to Reimburse for Separately Identifiable E&M Services
Horizon Blue Cross Blue Shield of New Jersey has announced it will recognize and reimburse chiropractors who bill separately identifiable services with modifier -25. The announcement follows a July 2006 administrative action by the Association of New Jersey Chiropractors (ANJC), which accused Horizon of various discriminatory tactics, including failing to pay DCs for separately identifiably Evaluation & Management (E&M) services performed on the same day as a chiropractic manipulation. According to the ANJC, the announcement is "a resounding victory against the improper reimbursement practices of Horizon with regard to E&M services performed by chiropractors." The association says it hopes to expand upon this victory and ultimately prevail on all points in the administrative action.
In 2005, the ANJC, upset with Horizon's insurance reimbursement practices, teamed with the American Chiropractic Association and brought its complaints to the New Jersey Department of Banking and Insurance (DOBI) for resolution. The DOBI transferred the dispute to the Office of Administrative Law, and in July 2006, a four-day hearing was held before the Administrative Law Judge. In addition to the...