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Medical Policy Criteria and Guidelines

TurningPoint will manage and maintain the medical policy criteria and guidelines that will be used to conduct PA/MND reviews as part of this program. The medical policy criteria and guidelines will be effective Monday, December 3, 2018 and will only apply to those Horizon BCBSNJ fully insured members included within the scope of this program.

  • You may obtain copies of the medical policy criteria and guidelines by calling TurningPoint at 1-833-436-4083, Monday through Friday between 8 a.m. and 5 p.m., Eastern Time (ET).
     
  • Beginning Monday, November 19, 2018, you may review the medical policy criteria and guidelines online. To access this information, sign in to NaviNet.net, select Horizon BCBSNJ from the My Health Plans menu, and:
    • Mouse over Referrals & Authorization and select TurningPoint PA/MND Requests
    • Select Help from the menu bar of TurningPoint’s home page
    • Select Medical Policies and Clinical Guidelines within the Helpful Articles section

Review the Surgical and Implantable Device Management Program Provider Training Manual for details.

If you do not have access to NaviNet, you may access the medical policy criteria and guidelines used to conduct PA/MND reviews as part of this program through TurningPoint’s web portal at https://www.myturningpoint-healthcare.com. To register for access to TurningPoint’s web portal, call TurningPoint at 1-833-436-4083, Monday through Friday between 8 a.m. and 5 p.m., ET to register to obtain access credentials.

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 surgical 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.