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Cardiac Services

Effective July 15, 2019, Horizon BCBSNJ will expand our Surgical and Implantable Device Management Program, administered by TurningPoint Healthcare Solutions, LLC (TurningPoint), to include Prior Authorization & Medical Necessity Determination (PA/MND) reviews for certain cardiac services, many of which may require the use of an implantable device.

TurningPoint will accept requests for PA/MND starting on July 1, 2019, for any in-scope cardiac procedures to be performed on or after July 15, 2019.

Review the procedures subject to PA/MND as part of our Surgical and Implantable Device Management Program for Cardiac Services.

Members included in this program for Cardiac Services

TurningPoint will conduct PA/MND reviews of services to be provided to members enrolled in the following plans/programs:

  • Horizon BCBSNJ fully insured plans/products, including those plans that include BlueCard® benefits for care received outside of our local service area (i.e., all NJ counties, the contiguous counties in DE, NY and PA, as well as Lehigh County, PA)

You can determine member eligibility and benefits by calling the phone number on the back to the member’s ID card. For BlueCard benefit inquiries call 1-800-676-2583.

TurningPoint will NOT conduct PA/MND reviews of services to be provided to members enrolled in self-insured Administrative Services Only (ASO) plans as part of this program.

Resources

Surgical and Implantable Device Management Program for Cardiac Services Q & A
Surgical and Implantable Device Management Program Provider Training Manual
Surgical and Implantable Device Management Program for Cardiac Services Procedure Code Listing

CPT® is a registered trademark of the American Medical Association.
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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.