Horizon BCBSNJ collaborates with TurningPoint to administer PA/MND review for certain orthopedic services, many of which require the use of an implantable device.
Members included in this program for orthopedic services
TurningPoint will conduct PA/MND reviews of services included in the scope of this program to be provided to members enrolled in the following plans/programs:
- Horizon BCBSNJ fully insured plans/products including those members enrolled in fully insured 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).
- Horizon BCBSNJ Medicare Advantage (MA) plans.
- State Health Benefits Program (SHBP)/School Employees’ Health Benefits Program (SEHBP) plans/products.
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.
TurningPoint Safety and Quality Award Program
Beginning April 1, 2021, orthopedic specialists will be offered the opportunity to participate in the TurningPoint Safety and Quality Award Program, in collaboration with Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ). This reward-based program will provide an incentive when your patients experience fewer complications, infections, hospital readmissions and Emergency Room visits following their surgical procedures, as well as reduced out-of-pocket costs associated with their surgery. To opt in, you must sign and return the addendum by March 1, 2021.
How it works
You must opt-in to the Safety and Quality Award Program to receive a quality award bonus payment. Award payments are calculated based on the performance of the surgeons within your orthopedic practice/group, and the following criteria must be met for each surgical procedure:
- Quality & Safety
- Infection & Risk Management
- Site of Service Optimization
- Procedure Documentation Standards
Incentive levels are categorized by type of service and based on your practice/group’s ability to demonstrate consistent use of the program’s best practice standards.
Those that do not enroll by March 1, 2021, may have a future opportunity to enroll the program on a quarterly basis.
TurningPoint Safety and Quality Award Program Upcoming Webinars
Attend one of the upcoming webinars for information about the Award program.
Jan 27, 2021 – 12 p.m.
Webinar ID: 771-812-123
Jan 28, 2021 – 9 a.m.
Webinar ID: 346-874-883
Feb 16, 2021 – 10 a.m.
Webinar ID: 325-043-763
Feb 19, 2021 – 1 p.m.
Webinar ID: 166-105-963
Mar 3, 2021 – 3 p.m.
Webinar ID: 651-373-819
Mar 9, 2021 – 12 p.m.
Webinar ID: 327-370-435
To use your computer's audio:
When the Webinar begins, you will be connected to audio using your computer's microphone and speakers (VoIP). A headset is recommended.
If you prefer to use your phone, you must select "Use Telephone" after joining the webinar and call in using the numbers below.
United States: (631) 992-3221
Access Code: 947-279-959
Audio PIN: Shown after joining the webinar
Surgical and Implantable Device Management Program for Orthopedic Services Q & A
Safety and Quality Award Program Q&A
Surgical and Implantable Device Management Program Provider Training Manual
Surgical and Implantable Device Management Program for Orthopedic Services Procedure Code Listing
Orthopedic Services Medical Policy Criteria and Guidelines
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 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.