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.
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.
- Beginning January 2, 2020, Turning Point will also perform review PA/MND for any in-scope orthopedic surgical procedure to be performed on or after January 20, 2020 for members enrolled in 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.
Resources
Surgical and Implantable Device Management Program for Orthopedic Services 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.
