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Surgical and Implantable Device Management Program Expands to include SHBP/SEHBP Plans

Beginning on January 20, 2020, our Surgical and Implantable Device Management program for cardiac and orthopedic surgrical services will expand to include members enrolled in State Health Benefits Program (SHBP)/School Employees’ Health Benefits Program (SEHBP) plans/products.

Horizon BCBSNJ works with TurningPoint Healthcare Solutions, LLC (TurningPoint) to review certain orthopedic and cardiac services, many of which may require an implantable device, for Prior Authorization & Medical Necessity Determination (PA/MND) review.

TurningPoint will accept requests for PA/MNDs starting on January 2, 2020 for any
in-scope cardiac/orthopedic surgical procedure to be performed on or after
January 20, 2020.

View more information about this program, including a full listing of the procedures and CPT® codes that are subject to PA/MND review under this program. You can also review information about the PA/MND review process and medical policy guidelines TurningPoint uses to conduct their reviews.

Questions?

Horizon BCBSNJ values your participation in our network and the care you provide to our members. If you have any questions, call TurningPoint at 1-833-436-4083 Monday through Friday between 8 a.m. and 5 p.m., Eastern Time.

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 surgical services that require an implantable device 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.

Published on: October 1, 2019, 02:10 AM ET
Last updated on: October 1, 2019, 03:53 AM ET