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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 or level-funded plans/products including those members enrolled in plans that include BlueCard® benefits for care received outside of our local service area.
  • Horizon Medicare Advantage (MA) plans including Braven Health℠.
  • State Health Benefits Program (SHBP)/School Employees’ Health Benefits Program (SEHBP) plans/products.
  • Federal Employee Plans® (FEP®)

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
Eligible orthopedic specialists may participate in the TurningPoint Safety and Quality Award Program, offered in collaboration with Horizon BCBSNJ. This reward-based program provides 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.

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.

For more information or to register for this program, please email providersupport@turningpoint-healthcare.com or call TurningPoint Provider Relations at 1-866-422-0800.

Resources

Surgical and Implantable Device Management Program for Orthopedic Services Q & A
Surgical and Implantable Device Management Program Provider Training Manual
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 Blue Shield Association.