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Orthopedic Services

Horizon BCBSNJ collaborates with TurningPoint to administer PA/MND review for certain orthopedic services, many of which require the use of an implantable device.

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

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.
https://global.gotowebinar.com/ojoin/966550297652826126/4280163872095070726
Webinar ID: 771-812-123

Jan 28, 2021 – 9 a.m.
https://global.gotowebinar.com/ojoin/8204884932441739278/4280163872095070726
Webinar ID: 346-874-883

Feb 16, 2021 – 10 a.m.
https://global.gotowebinar.com/ojoin/1115183379007213582/4280163872095070726
Webinar ID: 325-043-763

Feb 17, 2021 – 1 p.m.
https://global.gotowebinar.com/ojoin/3114470451983779343/4280163872095070726 Webinar ID: 164-028-427

Feb 19, 2021 – 1 p.m.
https://global.gotowebinar.com/ojoin/685254541552265487/4280163872095070726
Webinar ID: 166-105-963

Mar 2, 2021 – 10 a.m.
https://global.gotowebinar.com/ojoin/4195718092110833935/4280163872095070726 Webinar ID: 907-863-187

Mar 3, 2021 – 3 p.m.
https://global.gotowebinar.com/ojoin/6247588208959465231/4280163872095070726
Webinar ID: 651-373-819

Mar 9, 2021 – 12 p.m.
https://global.gotowebinar.com/ojoin/5863156062720692238/4280163872095070726
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.

Call in
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

Resources

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.