New review process for Spine Surgery services
Beginning November 1, 2016, Horizon Blue Cross Blue Shield of New Jersey will expand our collaboration with eviCore healthcare to require Prior Authorization and/or Medical Necessity Determination (PA/MND) review of certain Spine Surgery services. This new process focuses on ensuring you receive the right care at the right time.
Spine Surgery services will now be reviewed either pre- or post-service to:
- Determine medical necessity;
- Ensure the surgery is performed at the appropriate site of service; and
- Ensure appropriate conservative therapies are attempted prior to invasive procedures.
If you need or may need spinal surgery services, ask your doctor to obtain pre-service review.