Medical Policy Retirement: At Home Private Duty Nursing

Effective October 16, 2017, claims for private duty nursing will no longer be processed according to the guidelines of our medical policy At Home Private Duty Nursing. This medical policy will be removed from our Medical Policy Manual on October 16, 2017.

For services provided on and after October 16, 2017, claims for private duty nursing services provided to members enrolled in all Horizon BCBSNJ insured plans/products and Administrative Services Only (ASO) accounts (except those where Horizon BCBSNJ is secondary to Medicare or to another commercial carrier) will be processed using the MCG Care Guidelines on Private Duty Nursing. MCG’s corresponding assessment tool can be used to help determine the medical necessity of private duty nursing services.

For information about accessing the MCG Care Guidelines, please visit mcg.com, and click Care Guidelines.

If you are not already licensed to use MCG’s evidence-based tools, please:

• Visit mcg.com.
• Click Contact Us and select Sales Inquiry.
• Complete the requested information and click Submit.

If you have questions, please contact your Ancillary Reimbursement Analyst or Ancillary Contracting Specialist.