Reminder: Surgical and Implantable Device Management Program Launched
As recently announced, Horizon Blue Cross Blue Shield of New Jersey, in collaboration with TurningPoint Healthcare Solutions, LLC (TurningPoint), implemented a new specialty utilization management program on Monday, December 3, 2018.
As part of our Surgical and Implantable Device Management Program, TurningPoint will conduct Prior Authorization and Medical Necessity Determination (PA/MND) reviews of certain orthopedic surgery services, many of which may require the use of implantable devices. This applies to services that will be:
- Provided to your patients enrolled in Horizon BCBSNJ fully insured plans/products¹
- Performed by participating or nonparticipating physicians
- Rendered in an inpatient/outpatient hospital setting, an ambulatory surgical center or a physician’s office (services rendered in an observation setting or Emergency Room are excluded from this program).
¹Self-insured Administrative Services Only (ASO) members are not included in this program. You can look at the back of the member’s ID card to determine whether the plan is self-insured or fully insured. A self-insured ASO member ID card will state, “Horizon BCBSNJ provides administrative services only and does not assume any financial risk for claims.” A fully insured member’s ID card will not have that message. Please always verify member benefits, as it may be possible that the most current ID card is not presented at the time of service.
Procedures Included In This Program
Review the list of orthopedic surgery services included as part of this program.
Accessing TurningPoint through NaviNet®
A new transaction – TurningPoint PA/MND Requests – has been added within the Workflows for this Plan section in NaviNet, which allows users to:
- Submit PA/MND requests to TurningPoint
- Track and manage their authorizations
- Access medical policy criteria and guidelines for this program
NaviNet users must be granted access by their Security Officer to see and use this important new transaction. Learn about locating your practice’s Security Officer, or read more information about this new transaction.
Submitting A Request For PA/MND
To submit a PA/MND request to TurningPoint:
- Log on to NaviNet.net, select Horizon BCBSNJ from the My Health Plans menu, and:
- Mouse over Referrals & Authorization and select TurningPoint PA/MND Requests
- Select Requests within the menu bar of TurningPoint’s home page, or click the Add Request shortcut
- If you don’t have access to NaviNet, you can submit a request through TurningPoint’s web portal at https://www.myturningpoint-healthcare.com.
To register for access to TurningPoint’s web portal, call TurningPoint at 1-833-436-4083, Monday through Friday between 8 a.m. and 5 p.m., Eastern Time (ET).
- You may also call TurningPoint at this phone number to submit PA/MND requests.
You can review the information you should have available when requesting a PA/MND from TurningPoint.
Program Medical Policy Criteria & Guidelines
TurningPoint manages and maintains the medical policy criteria and guidelines used to conduct PA/MND reviews as part of this program. These criteria and guidelines pertain only to Horizon BCBSNJ fully insured members included in the scope of this program.
To access the medical policy criteria and guidelines:
- Log in to NaviNet.net select Horizon BCBSNJ from the My Health Plans menu, and:
- Mouse over Referrals & Authorization and select TurningPoint PA/MND Requests
- Select Help from the menu bar of TurningPoint’s home page
- Select Medical Policies and Clinical Guidelines within the Helpful Articles section
- Log on to TurningPoint’s web portal at https://www.myturningpoint-healthcare.com. To register for access to TurningPoint’s web portal, call TurningPoint at 1-833-436-4083, Monday through Friday between 8 a.m. and 5 p.m., ET, to register for access credentials.
- Call TurningPoint at 1-833-436-4083, Monday through Friday between 8 a.m. and 5 p.m., ET.
Program Details and Information
Information about this program including the following program resources are available by visiting HorizonBlue.com/turningpoint.
- Surgical and Implantable Device Management Program Provider Training Manual
- Surgical and Implantable Device Management Program Q&A
- Surgical and Implantable Device Management Program Procedure Code Listing
CPT® is a registered trademark of the American Medical Association.
NaviNet® is a registered trademark of NaviNet, Inc.
TurningPoint Healthcare Solutions, LLC supports Horizon Blue Cross Blue Shield of New Jersey in the administration and utilization management review of certain orthopedic surgical services for coverage. TurningPoint Healthcare Solutions, LLC is independent from, and not affiliated with Horizon Blue Cross Blue Shield of New Jersey or the Blue Cross and Blue Shield Association.
