Surgical and Implantable Device Management Program Participation
Patients enrolled in Federal Employee Program® (FEP®) plans are participating in our Surgical and Implantable Device Management Program (“the Program”).
Horizon BCBSNJ contracts with TurningPoint Healthcare Solutions, LLC (TurningPoint) to manage this Program.
TurningPoint conducts Prior Authorization & Medical Necessity Determination (PA/MND) reviews of certain orthopedic services and cardiac services (many of which include implantable devices), and other related services, to be rendered by participating and nonparticipating physicians when rendered in an inpatient; outpatient; ambulatory surgical center; or office setting.
Spine Services Program Participation to Begin August 14, 2023
Effective August 14, 2023, FEP members will also be participating in the Surgical and Implantable Device Management Program for Spine Services.
For the spine-related services included in this program, TurningPoint will begin accepting PA/MND requests beginning on July 31, 2023, for services to be provided to FEP members on and after August 14, 2023.
Please visit our Surgical and Implantable Device Management Program webpage for information and details about this program.
“TurningPoint Healthcare Solutions, LLC supports Horizon Blue Cross Blue Shield of New Jersey in the administration and utilization management review of certain orthopedic and cardiac 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.”
Prior Approval/Precertification for other Services
Please note that FEP members also may need Prior Approval and/or Precertification for other identified services. Information about these benefit details may be reviewed in section 3 of the Service Benefit Plan brochures.