# Horizon Blue Cross Blue Shield New Jersey

### Payerset Notes

**Table of Contents**

<https://mrf.payerset.com/horizon-bcbs-nj>

### Compliance Scorecard

Overall Rating: <mark style="color:green;">**4/5**</mark>**&#x20;- Good**

<table data-view="cards"><thead><tr><th></th><th></th><th></th><th></th><th data-hidden data-card-cover data-type="files"></th></tr></thead><tbody><tr><td><strong>Table of Contents</strong></td><td><strong>★★★★★</strong></td><td><mark style="color:green;"><strong>5/5</strong></mark></td><td><ul><li>Are the MRFs kept up to date each month?</li><li>Is the Table of Contents link easily accessible?</li><li>Is the Table of Contents properly formatted?</li></ul></td><td></td></tr><tr><td><strong>File Accessibility</strong></td><td><strong>★★★★☆</strong></td><td><mark style="color:green;"><strong>4/5</strong></mark></td><td><ul><li>Are there any barriers to downloading the files?</li><li>Do the Table of Contents links expire before publishing new links?</li></ul></td><td></td></tr><tr><td><strong>Data Quality</strong></td><td><strong>★★★★★</strong></td><td><mark style="color:green;"><strong>5/5</strong></mark></td><td><ul><li><p>What percentage of the MRFs are properly formatted and parseable</p><ul><li>5 Stars - 100%</li><li>4 Stars - 80%...</li></ul></li></ul></td><td></td></tr></tbody></table>

### Schema: HORIZON\_BCBS\_NJ

#### **Data Validation**

| Record Type                   | Record Count   |
| ----------------------------- | -------------- |
| Providers                     | 34,017,836,979 |
| Rates                         | 6,769,633,888  |
| Bundled Codes                 | 0              |
| Covered Services (Capitation) | 0              |

### Additional Observations

**Machine-Readable Price Transparency Files Review**

* **MRFs Up-to-Date:** ✔️ Yes, the MRFs are kept up to date each month.
* **Table of Contents Accessibility:** ✔️ The Table of Contents link is easily accessible.
* **Table of Contents Formatting:** ✔️ Yes, the Table of Contents is properly formatted.
* **File Download Barriers:** ✔️ No barriers to downloading the MRFs.
* **File Accessibility Percentage:** ✔️ All but 3 files are accessible.

**Overall Assessment Summary**

Horizon has substantially improved their file accessibility, only a few files are not available as compared to previously. This is a result of a combination of cleaning up old ToC links and also ensuring general file accessibility.

#### Data Integrity Findings

3 files inaccessible An error occurred while downloading file <https://urldefense.com/v3/**https://horizonbcbsnj.mrf.bcbs.com/2023-07\\_302\\_42A0\\_in-network-rates\\_2\\_of\\_3.json.gz?\\&Expires=1692367244\\&Signature=u1Vj82IXUxz1qTGSfLI1VGOepn970mdI87dlm71UV2Ayl11Rut4G4VGLCTKLHDXXkWcE6eCYnEATWfL-FXPr6JTGvqxO9dZIAMR3vyJVb-lkoaxU5Dreqmyu31gtH2GBtUPLgt1XXiqU6S8TQKZXrMWVQ1CDj5XuQd3cm3hqpTLOO3YuhdXjHgvAtId1R-U9KiRnqiq6yQ40KMeqbM1-1dnUKM5k**_**69QQV735ofNiEEWbPve01JWOiJAydcHh4rc6O2zZmMxGv**_**vHJwU-8nVe9qZ**_**7qNV93F46zFQYuQ**_**OFJZH3UE-VdG0tGCFCiBgPIor5GmVY0mOI5X8eGFbt-Tg**\\&Key-Pair-Id=K27TQMT39R1C8A\\_\\_;fn5-fg!!OUZQVuLPJGsF!zloRASAEJNecri-m5YbmTDvDyblg8CPkWNgavr7a-Z3ociQodA4nep9EEEDJX9v\\_pemx6CnlfZFYItmUu9orGJl1PXCst\\_A$> \_41d4f6dd47c509d64bff24ec6d07f2a68c2797fa: 403 Client Error: Forbidden for url: <https://horizonbcbsnj.mrf.bcbs.com/2023-07\\_302\\_42A0\\_in-network-rates\\_2\\_of\\_3.json.gz?\\&Expires=1692367244\\&Signature=u1Vj82IXUxz1qTGSfLI1VGOepn970mdI87dlm71UV2Ayl11Rut4G4VGLCTKLHDXXkWcE6eCYnEATWfL-FXPr6JTGvqxO9dZIAMR3vyJVb-lkoaxU5Dreqmyu31gtH2GBtUPLgt1XXiqU6S8TQKZXrMWVQ1CDj5XuQd3cm3hqpTLOO3YuhdXjHgvAtId1R-U9KiRnqiq6yQ40KMeqbM1-1dnUKM5k_~~_69QQV735ofNiEEWbPve01JWOiJAydcHh4rc6O2zZmMxGv_~~_vHJwU-8nVe9qZ_~~_7qNV93F46zFQYuQ_~~_OFJZH3UE-VdG0tGCFCiBgPIor5GmVY0mOI5X8eGFbt-Tg_\\_\\&Key-Pair-Id=K27TQMT39R1C8A>

Additionally, there are cases where billing code modifiers are both blank and non-blank, which can be confusing but should be interpreted that the given rate applies to both no modifier as well as the present modifier value. In the case below, the $1223.23 rate applies to no modifiers and RR modifiers.

<figure><img src="/files/PadTzgZSEoXWs47YVply" alt=""><figcaption></figcaption></figure>


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