Home Feed https://www.horizonblue.com/rss/home/feed en Medical Policy Revision: Electromyography and Nerve Conduction Studies https://www.horizonblue.com/providers/news/news-legal-notices/medical-policy-revision-electromyography-and-nerve-conduction-studies <span class="field field--name-title field--type-string field--label-hidden">Medical Policy Revision: Electromyography and Nerve Conduction Studies</span> <span class="field field--name-created field--type-created field--label-hidden">Mon, 07/15/2019 - 10:02</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>Effective <span class="class-bold">October 15, 2019</span>, Horizon BCBSNJ will change the way we consider certain professional claims based on revisions to our medical policy <span class="class-italic">Electromyography and Nerve Conduction Studies</span>.</p> <p>Access our <a href="https://services3.horizon-bcbsnj.com/hcm/MedPol2.nsf" target="_blank"><u>Medical Policy Manual</u></a> to review this medical policy content.</p> <hr> <p>Based on the submitted diagnosis code(s), claims submitted for services provided on and after October 15, 2019 to patients enrolled in Horizon BCBSNJ commercial and Administrative Services Only (ASO) plans will be processed as follows.</p> <ul> <li>The services represented by CPT<span class="superscript">®</span> codes <span class="class-bold">95912</span> or <span class="class-bold">95913</span> may be denied as experimental/investigational, non-covered services.</li> </ul> <ul> <li>Information may be requested to help us determine the medical appropriateness of the services represented by CPT codes <span class="class-bold">95912</span> or <span class="class-bold">95913</span>. Following our review of medical record information, these codes may be denied as experimental/investigational, non-covered services.</li> </ul> <p>Unless Horizon BCBSNJ gives written notice that all or part of the above changes have been canceled or postponed, the changes will be applied to claims for dates of service on and after October 15, 2019.</p> <p><small><span class="class-italic">CPT</span><span class="superscript"><span class="class-italic">®</span></span><span class="class-italic"> is a registered mark of the American Medical Association.</span></small></p> </div> Mon, 15 Jul 2019 14:02:01 +0000 horizonbcbsnj 4482 at https://www.horizonblue.com Additional Member Plans to be Included as part of our Surgical and Implantable Device Management Program for Orthopedic Surgeries https://www.horizonblue.com/members/news/member-news/additional-member-plans-to-be-included-as-part-of-our-surgical-and-implantable-device-management <span class="field field--name-title field--type-string field--label-hidden">Additional Member Plans to be Included as part of our Surgical and Implantable Device Management Program for Orthopedic Surgeries</span> <span class="field field--name-created field--type-created field--label-hidden">Mon, 07/15/2019 - 03:25</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>Beginning on <span class="class-bold">July 15, 2019, </span>the Surgical and Implantable Device Management program for orthopedic surgery services will expand to also apply to members enrolled in Horizon BCBSNJ Medicare Advantage plans.</p> <p>Through this program, TurningPoint Healthcare Solutions LLC (TurningPoint) conducts Prior Authorization &amp; Medical Necessity Determination (PA/MND) reviews for certain orthopedic surgery services that are requested by participating and nonparticipating physicians when rendered in the following settings¹:</p> <ul> <li>Inpatient</li> <li>Outpatient</li> <li>Ambulatory Surgical Center</li> <li>Physician’s Office</li> </ul> <p>Initially, this program only applied to Horizon BCBSNJ members enrolled in fully insured plans/products and in fully insured plans/products that include BlueCard® benefits for care received outside of Horizon BCBSNJ’s local service area. To determine member eligibility and benefits, your or your can call the phone number on the back to your member ID card.² ³</p> <p><span class="class-bold">Some of the most common services reviewed as part of this program include:</span></p> <table border="1" cellpadding="1" cellspacing="0" style="width:100%"> <tbody> <tr> <td style="vertical-align:TOP"> <p>Joint Reconstructive &amp; Fusion Surgeries<br /> <span class="class-italic">(Including all associated revision surgeries)</span></p> </td> </tr> <tr> <td style="vertical-align:TOP"> <ul> <li> <p>Knee Arthroplasty</p> </li> <li> <p>Hip Arthroplasty</p> </li> <li> <p>Shoulder Arthroplasty</p> </li> <li> <p>Elbow Arthroplasty</p> </li> <li> <p>Ankle Arthroplasty</p> </li> <li> <p>Wrist Arthroplasty</p> </li> <li> <p>Hip Resurfacing</p> </li> <li> <p>Shoulder Fusion</p> </li> <li> <p>Elbow Fusion</p> </li> <li> <p>Ankle Fusion</p> </li> <li> <p>Wrist Fusion</p> </li> </ul> </td> </tr> </tbody> </table> <p>&nbsp;</p> <table border="1" cellpadding="1" cellspacing="0" style="width:720px"> <tbody> <tr> <td style="vertical-align:TOP"> <p>Sports Medicine Surgeries</p> </td> </tr> <tr> <td style="vertical-align:TOP"> <ul> <li> <p>ACL Repair</p> </li> <li> <p>Acromioplasty &amp; Rotator Cuff Repair</p> </li> <li> <p>Femoroacetabular Arthroscopy</p> </li> <li> <p>Knee Arthroscopy</p> </li> <li> <p>Hip Arthroscopy</p> </li> <li> <p>Meniscal Repair (with or w/o Allograft)</p> </li> <li> <p>Osteochondral Defect Repair</p> </li> </ul> </td> </tr> </tbody> </table> <p>Your doctor can request a PA/MND for necessary orthopedic surgery services by calling TurningPoint at <span class="class-bold">1-833-436-4083</span> Monday through Friday between 8 a.m. and 5 p.m., Eastern Time. They may also find more details at <span class="class-bold"><a href="/providers/products-programs/surgical-and-implantable-device-management-program">HorizonBlue.com/turningpoint.</a></span></p> <p>You or your doctor may request copies of the medical policy criteria and guidelines that TurningPoint uses to conduct PA/MND reviews as part of this program by calling TurningPoint at <span class="class-bold">1-833-436-4083.</span></p> <p>As always, we encourage you to speak with your doctor about the orthopedic care that might be right for you. Horizon BCBSNJ remains committed to helping you access the care you need when you need it and reducing your out-of-pocket costs.</p> <p>&nbsp;</p> <p style="font-size:x-small">¹Services rendered in the observation setting and the Emergency Room (ER) are not reviewed by TurningPoint as part of this program.<br /> ² Horizon BCBSNJ members enrolled in plans that include BlueCard benefits who receive care outside of Horizon BCBSNJ’s service area which includes the State of New Jersey, contiguous counties in DE, NY and PA (as well as Lehigh County, PA).<br /> ³ For BlueCard benefit inquiries call <span class="class-bold">1-800-676-2583</span></p> <p style="font-size:x-small">&nbsp;</p> <p style="font-size:x-small">&nbsp;</p> <p style="font-size:x-small">CPT® is a registered trademark of the American Medical Association.<br /> NaviNet® is a registered trademark of NaviNet, Inc.<br /> TurningPoint Healthcare Solutions, LLC supports Horizon Blue Cross Blue Shield of New Jersey in the administration and utilization management review of certain surgical services that require an implantable device 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.</p> </div> Mon, 15 Jul 2019 07:25:35 +0000 horizonbcbsnj 4474 at https://www.horizonblue.com Electromyography and Nerve Conduction Studies https://www.horizonblue.com/node/4481 <span class="field field--name-title field--type-string field--label-hidden">Electromyography and Nerve Conduction Studies</span> <span class="field field--name-created field--type-created field--label-hidden">Fri, 07/12/2019 - 09:14</span> <div class="field field--name-field-medical-policy-type field--type-entity-reference field--label-above"> <div class="field__label">Medical policy type</div> <div class="field__item"><a href="/taxonomy/term/49" hreflang="en">Revised</a></div> </div> <div class="field field--name-field-third-party-url field--type-string field--label-above"> <div class="field__label">Third Party URL</div> <div class="field__item">https://services3.horizon-bcbsnj.com/hcm/MedPol2.nsf/MedicalPolicies/RFMI-9NLN5A</div> </div> Fri, 12 Jul 2019 13:14:22 +0000 horizonbcbsnj 4481 at https://www.horizonblue.com Member Portal Maintenance https://www.horizonblue.com/members/news/member-alerts/member-portal-maintenance-0 <span class="field field--name-title field--type-string field--label-hidden">Member Portal Maintenance</span> <span class="field field--name-created field--type-created field--label-hidden">Fri, 07/12/2019 - 08:36</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>Horizon BCBSNJ's Member Portal will undergo scheduled maintenance beginning at 8 p.m. July 12, 2019 until 8 a.m. July 15, 2019. During this time you may experience intermittent issues with some transactions. We apologize for the inconvenience and appreciate your patience.</p> </div> Fri, 12 Jul 2019 12:36:10 +0000 horizonbcbsnj 4480 at https://www.horizonblue.com Member Portal Maintenance https://www.horizonblue.com/members/news/member-alerts/member-portal-maintenance <span class="field field--name-title field--type-string field--label-hidden">Member Portal Maintenance</span> <span class="field field--name-created field--type-created field--label-hidden">Thu, 07/11/2019 - 10:47</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>Horizon BCBSNJ's Member Portal will undergo scheduled maintenance beginning at 8 p.m. July 11, 2019 until 8:20 p.m. July 11, 2019. We apologize for the inconvenience and appreciate your patience.</p> </div> Thu, 11 Jul 2019 14:47:02 +0000 horizonbcbsnj 4479 at https://www.horizonblue.com Taking Care of Your Health https://www.horizonblue.com/members/education-center/medicare-advantage/taking-care-of-your-health <span class="field field--name-title field--type-string field--label-hidden">Taking Care of Your Health</span> <span class="field field--name-created field--type-created field--label-hidden">Wed, 07/10/2019 - 03:35</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>Learn more about how to get and stay well.</p> <p class="class-bold">Preventive Screenings</p> <p>Managing your health includes preventive care, even when you’re not feeling sick. Preventive screenings are an important part of staying healthy.Talk to your doctor about which screenings are right for you.</p> <ul> <li><span class="class-bold">Breast Cancer Screening</span> <p>Did you know that three out of four women who get breast cancer have no family history of the illness? The best protection is early detection. Routine mammograms are covered by your health plan, at no cost to you, so talk to your doctor about when and how often you should be getting a mammogram. All you need is a prescription from your doctor.</p> <p>A mammogram can:</p> <ul style="list-style-type:circle;"> <li>Detect symptoms years before you can feel a lump</li> <li>Find cancer early, when it’s most treatable, but only if you have the screening every year</li> <li>Take as little as 20 minutes with minimal discomfort for most women</li> </ul> <p>Plus, you can receive a $50 CVS gift card when you complete your mammogram. Learn more about earning rewards by completing your preventive health screenings through the <u><a href="/members/education-center/medicare-advantage/staying-healthy-and-saving-money">Horizon Healthy Journey Program</a></u>. The program is available to members who have a Horizon Medicare Advantage plan (HMO or PPO).</p> </li> </ul> <ul> <li><span class="class-bold">Top 5 Things to Talk About at Your Annual Wellness Visit </span> <p>When you have your Annual Wellness Visit with your Primary Care Physician (PCP), be sure to have an open discussion and remember to ask questions. Your PCP will create a personalized care plan that treats all your conditions, so being honest about your health concerns helps your doctor help you.</p> <p>Talk about:</p> <ol> <li> <p><span class="class-bold">Falls:</span> Certain health issues or living conditions may increase your chance of falling and these risk factors increase as you age. Always tell your doctor about any falls you have had in the past. Ask about taking a falls risk assessment.</p> </li> </ol> <ol start="2"> <li> <p><span class="class-bold">Blood pressure:</span> Make sure your doctor checks your blood pressure at every visit. If it’s high, ask how you can lower your blood pressure to avoid health issues like a stroke, heart disease and kidney failure.</p> </li> </ol> <ol start="3"> <li> <p><span class="class-bold">Preventive care:</span> If you had a fracture (broke a bone) in the last six months, you should get a DEXA scan to assess your bone health. Other important screenings to discuss are breast cancer, colorectal cancer and diabetes.</p> </li> </ol> <ol start="4"> <li> <p><span class="class-bold">How you are feeling:</span> Let your doctor know if you’re feeling sad or depressed. You may benefit from talking with a behavioral health professional who can help you learn skills to cope with negative feelings or prescribe medication to manage depression.</p> </li> </ol> <ol start="5"> <li> <p><span class="class-bold">Medications:</span> Follow the directions on your medicine bottles and don’t forget to take them even if you feel like they aren’t working. If you have side effects, let your doctor know right away. You must take your medication correctly for it to work properly. Not taking your medication correctly can cause serious damage to your health.</p> </li> </ol> <p>Plus, you can receive a $25 CVS gift card when you complete your Annual Wellness Visit. Learn more about earning rewards by completing your preventive health screenings through the <u><a href="/members/education-center/medicare-advantage/staying-healthy-and-saving-money">Horizon Healthy Journey Program</a></u>. The program is available to members who have a Horizon Medicare Advantage plan (HMO or PPO).</p> </li> </ul> <p class="class-bold">Health and Wellness</p> <p>Staying healthy helps keep your body and mind strong, and can help prevent illness. Regular visits to your doctor, along with other tests and screenings, can help prevent certain health conditions, such as heart disease, stroke and high blood pressure. Taking care of yourself today can help keep you healthy tomorrow.</p> <ul> <li><span class="class-bold">Falls Risk Assessment</span> <p>Did you know that falling once doubles your chances of falling again? If you fall and injure yourself, you may lose the ability to live independently. Factors that can increase your risk include weakness in your legs, low levels of vitamin D, certain medications, vision problems, foot pain, poorly fitted shoes, uneven steps, throw rugs and items left on the ground.</p> <p>Ask yourself:</p> <ul style="list-style-type:circle;"> <li>Have you fallen or tripped in the past year?</li> <li>Do you ever feel unsteady when walking?</li> <li>Do you need to push with your hands to stand up from a chair?</li> <li>Do you take medicine that makes you tired or dizzy?</li> <li>Have you ever lost feeling in your feet?</li> <li>Do you have weakness in your legs?</li> </ul> <p>If you answered “yes” to any of these questions, schedule your annual checkup with your Primary Care Physician and ask for a Falls Risk Assessment.</p> <p>Sometimes making simple changes to your home or lifestyle can help keep you from falling.</p> <p>Consider:</p> <ul style="list-style-type:circle;"> <li>Asking for help to bring in the groceries</li> <li>Cleaning up clutter in hallways and on staircases</li> <li>Installing handrails in hallways and on staircases, and in bathrooms</li> <li>Repairing or removing tripping hazards like as loose carpeting, throw rugs or floorboards</li> </ul> <p>Use our <u><a href="https://doctorfinder.horizonblue.com/">Doctor &amp; Hospital Finder</a></u> to find a doctor, or any other specialist, hospital or lab.</p> </li> </ul> <ul> <li><span class="class-bold">High blood pressure: Do you know your numbers? </span> <p>High blood pressure, also known as hypertension, is often called a “silent killer.” Many people don’t know that they have it because it often has no warning signs or symptoms. The only way to know if you have hypertension is to measure your blood pressure. If you have high blood pressure, your doctor may prescribe medications for you to take.</p> <p>Blood pressure is measured using two numbers – <span class="class-bold">systolic </span>and <span class="class-bold">diastolic</span>:</p> <ul> <li><span class="class-bold">Normal:</span> <ul style="list-style-type:square;"> <li>Systolic: <span class="class-bold">&lt;120 mmHg</span></li> <li>Diastolic: <span class="class-bold">&lt;80 mmHg</span></li> </ul> </li> <li><span class="class-bold">At risk:</span> <ul style="list-style-type:square;"> <li>Systolic: <span class="class-bold">120-139 mmHg</span></li> <li>Diastolic: <span class="class-bold">80-89 mmHg</span></li> </ul> </li> <li><span class="class-bold">High:</span> <ul style="list-style-type:square;"> <li>Systolic: <span class="class-bold">140+ mmHg</span></li> <li>Diastolic: <span class="class-bold">90+ mmHg</span></li> </ul> </li> </ul> <p>Check with your doctor to know if your blood pressure is within a safe range.</p> <p>Use our <u><a href="https://doctorfinder.horizonblue.com/">Doctor &amp; Hospital Finder</a></u> to find a doctor, or any other specialist, hospital or lab.</p> </li> </ul> </div> Wed, 10 Jul 2019 07:35:30 +0000 horizonbcbsnj 4478 at https://www.horizonblue.com Staying Healthy and Saving Money https://www.horizonblue.com/members/education-center/medicare-advantage/staying-healthy-and-saving-money <span class="field field--name-title field--type-string field--label-hidden">Staying Healthy and Saving Money</span> <span class="field field--name-created field--type-created field--label-hidden">Wed, 07/10/2019 - 03:33</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>Learn more about how you can earn and save, and take care of your health.</p> <p class="class-bold">Horizon Healthy Journey</p> <p>Learn how to take care of your health and earn rewards with the Horizon Healthy Journey Program.</p> <div class="col-md-12 col-sm-12 tab-navig"> <div class="row"> <div class="col-md-12"><!--p>Our Case Management program offers support, guidance and valuable information to help you manage a complex medical situation. Our specialty case management programs include our High-Risk Maternity, Post-Discharge Contact and Organ Transplant programs</p--> <div class="panel with-nav-tabs panel-default"> <ul class="nav nav-tabs responsive" id="myTab"> <li class="active custom-tabs"><a data-toggle="tab" href="#resp-tab1">Introduction</a></li> <li class="custom-tabs"><a data-toggle="tab" href="#resp-tab4">Partnered vendors</a></li> <li class="custom-tabs"><a data-toggle="tab" href="#resp-tab3">Rewards &amp; Incentive</a></li> <li class="custom-tabs"><a data-toggle="tab" href="#resp-tab2">Keep You on Track</a></li> </ul> <div class="tab-content responsive"> <div class="tab-pane fade in active" id="resp-tab1"> <p>The Horizon <em>Healthy Journey</em> Program is here to help you get the information you need to take care of your health. We focus on the importance of preventive health screenings through education and engagement. The Horizon <em>Healthy Journey</em> Program offers:</p> <ul> <li><span class="class-bold">Personal Touch:</span> Our care team makes one-on-one calls for health screening reminders, health education and chronic disease management.</li> <li><span class="class-bold">All Stages of Life:</span> You can count on us for support through all stages of life.</li> <li><span class="class-bold">Awareness:</span> Our educational materials and health screening reminders are tailored to your needs.</li> <li><span class="class-bold">Rewards and Incentive:</span> We make it easy for you to earn rewards just for being active in your wellness journey. You may be eligible to earn rewards when you complete certain preventive health screenings.</li> </ul> <p class="class-bold">Your journey to better health begins here!</p> <p><span class="class-bold">Getting the right care starts with an annual wellness visit with your Primary Care Physician (PCP).</span> During this visit, your PCP will talk to you about your:</p> <ul> <li>Blood pressure</li> <li>Cholesterol</li> <li>Body mass index (BMI)</li> <li>Risk of falling</li> <li>Needed preventive health screenings and vaccinations</li> </ul> <p class="class-bold">An annual wellness visit is a covered benefit, <em>at no cost to you</em>.</p> <p><span class="class-bold">Contact us:</span> If you have any concerns that make it difficult for you to get your preventive health screenings, please call the Horizon <em>Healthy Journey</em> line <span class="class-bold">1-844-754-2451</span> (TTY <span class="class-bold">711</span>), Monday to Friday, from 8:30 a.m. to 5 p.m., Eastern Time (ET).</p> <p>For questions regarding your coverage, benefits or eligibility please contact Member Services at <span class="class-bold">1-800-365-2223</span> (TTY <span class="class-bold">711</span>), Monday to Friday, from 8 a.m. to 8 p.m., ET.</p> </div> <div class="tab-pane fade" id="resp-tab2"> <p>Throughout the year, Horizon <em>Healthy Journey</em> will remind you when it’s time for your preventive health screenings. You may hear from us through live or automated calls, or we may send you reminders in the mail. Horizon <em>Healthy Journey</em> will let you know when you are due for any of the following:</p> <ul> <li>Breast cancer screening – mammogram</li> <li>Osteoporosis Management in Women – DEXA scan</li> <li>Vaccines – Flu, pneumococcal and shingles vaccine</li> <li>Diabetes screenings – Hemoglobin A1C, Microalbumin lab test, and diabetic eye exam.</li> <li>Colorectal cancer screening</li> <li>Annual wellness visit</li> </ul> <p>Preventive health screenings are the best way to find and treat any problems early, when chances for successful treatment are best. If you have any questions about the screenings above, call us at <span class="class-bold">1-888-754-2451</span> (TTY <span class="class-bold">711</span>), Monday to Friday from 8:30 a.m. to 5 p.m., ET.</p> <p>&nbsp;</p> </div> <div class="tab-pane fade" id="resp-tab3"> <p>The Rewards and Incentive Program promotes staying healthy by completing your preventive health screenings while earning rewards. It is available to members who have a Horizon Medicare Advantage plan (HMO or PPO).</p> <p class="class-bold">It’s easy to participate in the Rewards and Incentive Program:</p> <ol> <li>Visit your Primary Care Physician (PCP) for your annual visit and preventive health screenings in 2019.</li> <li>Complete and submit the <a href="/RandIRedemptionform">Gift Card Redemption Form</a>.</li> <li>Submit your <a href="/RandIRedemptionform">Redemption Forms</a>&nbsp;by the following deadlines: <ul style="list-style-type:circle;"> <li>By <span class="class-bold">August 31, 2019</span> for screenings completed from <span class="class-bold">January 1, 2019</span> to <span class="class-bold">June 30, 2019</span></li> <li>By <span class="class-bold">January 31, 2020</span> for screenings completed from <span class="class-bold">July 1, 2019</span> to <span class="class-bold">December 31, 2019</span></li> </ul> </li> </ol> <p>All health screening(s) must be completed between <span class="class-bold">January 1, 2019</span> and <span class="class-bold">December 31, 2019</span>. Screenings completed before 2019 are <span class="class-bold">NOT EIGIBLE</span> for gift card redemption.</p> <p>You must be enrolled in an eligible Horizon Medicare Advantage plan at the time you complete your screening(s).</p> <p>If you prefer to send your form via mail, please contact Horizon<i> Healthy Journey</i> at<span class="class-bold"> 1-844-754-2451</span> (TTY <span class="class-bold">711</span>), Monday through Friday, from 8:30 a.m. to 5 p.m., Eastern Time (ET) to request a paper copy of the Gift Card Redemption Form or print the <a href="/sites/default/files/2019_R&amp;I_Gift_Card_Redemption_Form.pdf">Gift Card Redemption Form</a>.</p> <p>Rewards and Incentive Program FAQs:</p> <ul> <li><span class="class-bold">Am I required to participate?</span> <ul style="list-style-type:circle;"> <li>No, this program is voluntary and does not affect your enrollment or benefits.</li> </ul> </li> <li><span class="class-bold">How do I know which screenings I need?</span> <ul style="list-style-type:circle;"> <li>We will send you a letter along with the <a href="/RandIRedemptionform">redemption form</a> that lists all the screening(s) you may need. You should then talk to your doctor about which screening(s) is best for you.</li> </ul> </li> <li><span class="class-bold">How will Horizon BCBSNJ know that I completed my screenings?</span> <ul style="list-style-type:circle;"> <li>All screenings are validated with claims.</li> </ul> </li> <li><span class="class-bold">What kind of purchases can I make with the CVS gift card? </span> <ul style="list-style-type:circle;"> <li>The gift card can be used for in-store purchases, except for money orders, prepaid cards, online or in-app purchases.</li> </ul> </li> </ul> <ul> <li><span class="class-bold">How long does it take to receive the gift card(s)</span>? <ul style="list-style-type:circle;"> <li>When we receive your completed <a href="/RandIRedemptionform">Gift Card Redemption Form</a>, Horizon BCBSNJ will record your form and completed screenings for validation. <ul style="list-style-type:circle;"> <li>We will then wait to receive a claim from your doctor or facility where the test was completed. This process may take up to 90 days from the date you completed your screening.</li> <li>Once the screening is verified, we will send the CVS gift card to the address provide on the <a href="/RandIRedemptionform">form</a>, within 4-6 weeks. Missing information on the form may delay the processing of your gift card.</li> </ul> </li> </ul> </li> </ul> <p class="class-bold">Which health screenings are eligible for a reward?</p> <table> <tbody> <tr> <td class="class-bold">Screening</td> <td class="class-bold">Reward</td> </tr> <tr> <td>Annual Wellness Visit</td> <td>$25 CVS gift card</td> </tr> <tr> <td>Mammogram</td> <td>$50 CVS gift card</td> </tr> <tr> <td>Colonoscopy or Sigmoidoscopy</td> <td>$50 CVS gift card</td> </tr> <tr> <td>Fecal Occult Blood Test (FOBT) kit or Stool DNA</td> <td>$15 CVS gift card</td> </tr> <tr> <td>DEXA scan</td> <td>$50 CVS gift card</td> </tr> <tr> <td>Diabetic eye exam (<em>recommended for diabetics</em>)</td> <td>$25 CVS gift card</td> </tr> </tbody> </table> </div> <div class="tab-pane fade" id="resp-tab4"> <p>Horizon Blue Cross Blue Shield of New Jersey has partnered with certain vendors to help you get the screenings you need quickly and easily. You may be contacted by one of the vendors below on our behalf, if you are eligible for a certain screening(s). If you get a call or receive mail from one of our partnered vendors, we have given them permission to reach out to you.</p> <ul style="list-style-type:circle"> <li><span class="class-bold">Magellan Rx:</span> A team of pharmacists that contact members for the following: <ol> <li><span class="class-bold">Osteoporosis Management in Women</span> — Magellan Rx educates members about the risks of osteoporosis and the importance of completing a Bone Density Mineral test/DEXA scan. They will also contact women between the ages of 65-87 that had a fracture in the past six months.</li> <li><span class="class-bold">Statin Therapy for Patients with Cardiovascular Disease</span> — Magellan Rx educates members who are at risk for cardiovascular disease and may benefit from statin therapy.</li> </ol> <p>&nbsp;Magellan Rx services are offered to members in the following Medicare Advantage HMO plans:</p> <ul> <li>Horizon Medicare Blue Value (HMO)</li> <li>Horizon Medicare Blue Value w/Rx (HMO)</li> <li>Horizon Medicare Blue Choice w/Rx (HMO)</li> <li>Horizon Medicare Blue Access Group (HMO-POS)</li> <li>Horizon Medicare Blue Access Group w/Rx (HMO-POS)</li> <li>Horizon Medicare Blue Access Group w/Rx Value (HMO-POS)</li> <li>Horizon Medicare Blue Advantage (HMO)</li> <li>Horizon Medicare Blue Select (HMO-POS)</li> </ul> </li> <li><span class="class-bold">Mobile Medical Examination services, MedXm</span>: A specialized team of licensed, credentialed and professional technicians that perform in-home screenings for: <ul style="list-style-type:circle"> <li>Colorectal cancer</li> <li>Diabetic retinal eye exam</li> <li>Hemoglobin A1c</li> <li>Microalbumin test</li> <li>DEXA scan</li> </ul> </li> </ul> <p>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; MedXm services are offered to members enrolled in either Medicare Advantage HMO or PPO plans.</p> </div> </div> </div> </div> </div> </div> <p class="class-bold">Home Delivery Pharmacy Service</p> <p>Understanding your pharmacy benefits through Horizon Blue Cross Blue Shield of New Jersey can help save you time and money. Horizon Medicare Advantage members use AllianceRx Walgreens Prime for convenient home delivery pharmacy service.</p> <p>Home delivery pharmacy service is safe, convenient and could save you money:</p> <ul> <li>No more waiting in line at the pharmacy</li> <li>A record of your medications is always available</li> <li>With 90-day supplies, you could have fewer copayments</li> <li>Free standard shipping, refill reminders and an auto-refill program</li> <li>Delivery anywhere in the United States, even when you’re away from home</li> <li>Medicines shipped in tamper-evident containers and delivered in plain packaging for privacy</li> </ul> <p>A licensed pharmacist always processes your order and you can speak with the pharmacy team any time.</p> <p>To start using the home delivery pharmacy service, visit <u><a href="https://www.alliancerxwp.com/home-delivery">alliancerxwp.com/home-delivery</a></u> and follow the instructions to create an account. Once you’ve created an account, you can ask your doctor to send your prescription electronically to AllianceRx Walgreens Prime, or fax a prescription request to <span class="class-bold">1-800-332-9581</span>.</p> <p class="class-bold">Healthy Discounts</p> <p>Learn more about <a href="/members/wellness/living-savings/healthy-discounts">Blue365®</a>, a discount program administered by the Blue Cross Blue Shield Association that offers eligible Horizon BCBSNJ members savings on products and services for a well-balanced lifestyle. Blue365® deals can help members stay active, while saving money at popular retailers and companies nationwide. Blue365® deals are offered in addition to the benefits of a member’s health plan. <a href="https://www.blue365deals.com/">Enroll today</a>.</p> </div> Wed, 10 Jul 2019 07:33:27 +0000 horizonbcbsnj 4477 at https://www.horizonblue.com Getting to Know Medicare https://www.horizonblue.com/members/education-center/medicare-advantage/getting-to-know-medicare <span class="field field--name-title field--type-string field--label-hidden">Getting to Know Medicare</span> <span class="field field--name-created field--type-created field--label-hidden">Wed, 07/10/2019 - 03:01</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>Valuable guidance and important information for a better understanding of Medicare.</p> <p class="class-bold">Learning More About Your Medicare Plan</p> <p>When you enroll in Original Medicare, you get Part A Hospital coverage and Part B Medical coverage. But Original Medicare doesn’t cover all of your medical costs. If you want prescription drug coverage, you can buy a separate Part D plan. Or, you may decide to get all your coverage in one plan from a private insurance company, like Horizon BCBSNJ. Part C – Medicare Advantage – gives you all the benefits in one convenient plan, often including Part D, as well as other extra benefits like vision, hearing and dental.</p> <p class="class-bold">Understanding How Medicare Works</p> <p>After you’ve enrolled in the Medicare plan that best suits your needs, you’ll want to understand how it all works so get the most from your plan.</p> <p class="class-bold">Learn more about the different parts of Medicare.</p> <p class="class-bold">The A, B, C D’s of Medicare</p> <p><iframe align="middle" allowtransparency="true" frameborder="0" height="320" scrolling="no" src="https://player.piksel.com/a/i0vvn1q7" width="480"></iframe></p> <p>&nbsp;</p> <p class="class-bold">Understand the difference between Original Medicare and Medicare Advantage.</p> <p class="class-bold">Original Medicare or Medicare Advantage – What’s the difference?</p> <p><iframe align="middle" allowtransparency="true" frameborder="0" height="320" scrolling="no" src="https://player.piksel.com/a/xlslrye6" width="480"></iframe></p> <p>&nbsp;</p> <p class="class-bold">Learn how to save money on your medicines.</p> <p class="class-bold">Save Money on Your Prescription Medications</p> <p><iframe align="middle" allowtransparency="true" frameborder="0" height="320" scrolling="no" src="https://player.piksel.com/a/a6gw75ac" width="480"></iframe></p> <p>&nbsp;</p> <p class="class-bold">How does my other insurance work with Medicare?</p> <p>When you have other insurance and Medicare, there are rules for whether Medicare or your other insurance pays first.</p> <ul> <li>If you have retiree insurance (insurance from your or your spouse’s former employment): <span class="class-bold">Medicare pays first. </span></li> <li>If you’re 65 or older, have group health plan coverage based on your or your spouse’s current employment, and the employer has 20 or more employees: <span class="class-bold">Your group health plan pays first. </span></li> <li>If you’re 65 or older, have group health plan coverage based on your or your spouse’s current employment, and the employer has fewer than 20 employees: <span class="class-bold">Medicare pays first. </span></li> <li>If you’re under 65 and have a disability, have group health plan coverage based on your family member’s current employment, and the employer has 100 or more employees: <span class="class-bold">Your group health plan pays first. </span></li> <li>If you’re under 65 and have a disability, have group health plan coverage based on your or a family member’s current employment, and the employer has fewer than 100 employees: <span class="class-bold">Medicare pays first. </span></li> <li>If you have Medicare because of End-Stage Renal Disease (ESRD): <span class="class-bold">Your group health plan will pay first for the first 30 months after you become eligible to enroll in Medicare. Medicare will pay first after this 30-month period. </span></li> </ul> <p>Note: In some cases, your employer may join with other employers or unions to form or sponsor a multiple-employer plan. If this happens, the size of the largest employer/union determines whether Medicare pays first or second.</p> <p>Here are some important facts to remember:</p> <ul> <li>The insurance that pays first (primary payer) pays up to the limits of its coverage.</li> <li>The insurance that pays second (secondary payer) only pays if there are costs the primary insurer didn’t cover.</li> <li>The secondary payer (which may be Medicare) might not pay all of the uncovered costs.</li> <li>If your employer insurance is the secondary payer, you might need to enroll in Part B before your insurance will pay.</li> <li>Medicaid pays after Medicare.</li> </ul> <p>Source: U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES; Centers for Medicare &amp; Medicaid Services; CMS Product No. 10050; Revised November 2018</p> </div> Wed, 10 Jul 2019 07:01:29 +0000 horizonbcbsnj 4476 at https://www.horizonblue.com Medicare Advantage https://www.horizonblue.com/members/education-center/medicare-advantage <span class="field field--name-title field--type-string field--label-hidden">Medicare Advantage</span> <span class="field field--name-created field--type-created field--label-hidden">Wed, 07/10/2019 - 02:38</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>Learn more about your Medicare Advantage plan to get the most from your benefits.</p></div> Wed, 10 Jul 2019 06:38:25 +0000 horizonbcbsnj 4475 at https://www.horizonblue.com Get the Facts on Fiber https://www.horizonblue.com/members/wellness/my-health-manager/get-facts-on-fiber <span class="field field--name-title field--type-string field--label-hidden">Get the Facts on Fiber</span> <span class="field field--name-created field--type-created field--label-hidden">Tue, 07/02/2019 - 06:06</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p><span class="class-bold">Foods high in fiber are generally low in fat and calories, fill you up more, and keep you full longer. Plus, the same<br /> foods that are high in fiber tend to be high in essential vitamins, minerals, antioxidants, and sometimes even protein.</span></p> <p>As it moves through your digestive tract, fiber also absorbs cholesterol, cancer-causing toxins, and prevents constipation. Fiber can also protect against heart disease and diabetes.</p> <p>Women should aim for at least 25 grams of fiber a day, and men should try get at least 30 grams a day.</p> <p>Here are some fiber-rich foods to help you increase your intake.</p> <ul> <li>Whole Grains: 6-8 ounces per day (18-40 grams of fiber)</li> <li>Fruits: 2 cups per day (7-8 grams)</li> <li>Vegetables: 2 1/2 cups per day (5-10 grams)</li> <li>Seeds: A handful of chia, flax or sunflower seeds (3-4 grams)</li> </ul> <p>Here are some ways to add more fiber to your diet:</p> <ul> <li>Read food labels; look for items that have at least 2 1/2 grams of fiber per serving.</li> <li>Eat whole fruit instead of drinking fruit juice, which has less fiber.</li> <li>Add beans to dishes like soups, salad and chili.</li> </ul> <p>To get all of fiber’s benefits, you need the soluble type, which can be found in nuts, beans and apples, and the insoluble type, which is in whole-wheat bread and fruit skins.</p> <p>However, some gastrointestinal conditions, as well as cancer treatments, may require a low-fiber diet. To stay healthy without irritating your stomach, choose ripened fruit, like bananas and peaches, and well-cooked or canned vegetables.</p> <p>Visit <a href="https://doctorfinder.horizonblue.com">HorizonBlue.com/doctorfinder</a> to find in-network doctors and hospitals so you can get the care you need when you need it.</p> <p><small>Sources: Krames Patient Education, WebMD®</small></p> </div> Tue, 02 Jul 2019 10:06:07 +0000 horizonbcbsnj 4473 at https://www.horizonblue.com Need motivation to get moving? https://www.horizonblue.com/members/wellness/my-health-manager/need-motivation-to-get-moving <span class="field field--name-title field--type-string field--label-hidden">Need motivation to get moving?</span> <span class="field field--name-created field--type-created field--label-hidden">Tue, 07/02/2019 - 02:24</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>We all know we need exercise. Most health organizations agree that to prevent heart attacks, strokes, diabetes and certain cancers, we need to exercise at least 30 minutes a day five days a week. But actually doing it is another story.</p> <p>While we may make excuses to avoid exercise, the fact remains that not exercising will contribute to your risk of chronic disease. Here are some tips to make exercise goals attainable:</p> <ul> <li> <p><span class="class-bold">Set reasonable goals:</span> Start small, especially if you are just starting out. Gradually work your way up to the recommended minimum.</p> </li> <li> <p><span class="class-bold">Track your progress:</span> Keep a record of your workouts using a mobile app or pen and paper. Seeing progress, such as running faster, can motivate you to keep improving.</p> </li> <li> <p><span class="class-bold">Ban guilt:</span> There may be days when you don’t meet your own goals and expectations. That’s ok. Just get back on track the next day.</p> </li> <li> <p><span class="class-bold">Ban comparisons:</span> There will always be someone fitter, faster or more flexible than you. Don’t let that deter you. Your workout is about you.</p> </li> <li> <p><span class="class-bold">Find social support:</span> Online communities can offer encouragement, and so can a friend who wants to work out with you. An hour on a treadmill can fly by when you have someone to talk to.</p> </li> <li> <p><span class="class-bold">Find exercise you enjoy:</span> Try different things, such as dancing, gardening, swimming, or playing a sport. Exercise does not need to happen in a gym. Even if you don’t like most forms of physical activity, find something you can live with. Your body needs it, and you may even start enjoying it once the activity becomes a habit and you start seeing some benefits.</p> </li> <li> <p><span class="class-bold">Break it up:</span> The recommended 50 minutes per week can be divided up any way you’d like. If smaller increments work better, go for it!</p> </li> <li> <p><span class="class-bold">Reward yourself:</span> Acknowledge your success with a treat that isn’t food based, such as a massage or ball game tickets.</p> </li> </ul> <p>Visit <span class="class-bold"><a href="https://doctorfinder.horizonblue.com/">HorizonBlue.com/doctorfinder</a></span> to find in-network doctors and hospitals so you can get the care you need when you need it.</p> <p>Source: WebMD®</p> </div> Tue, 02 Jul 2019 06:24:31 +0000 horizonbcbsnj 4471 at https://www.horizonblue.com Reminder: Our Laboratory Network to Offer More Choice https://www.horizonblue.com/providers/news/news-legal-notices/reminder-our-laboratory-network-to-offer-more-choice <span class="field field--name-title field--type-string field--label-hidden">Reminder: Our Laboratory Network to Offer More Choice</span> <span class="field field--name-created field--type-created field--label-hidden">Tue, 07/02/2019 - 01:55</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>As a reminder, Horizon BCBSNJ is expanding its laboratory network to help increase members’ access to quality care. Beginning <span class="class-bold">January 1, 2019</span>, Horizon BCBSNJ will provide more participating national clinical laboratory choices for you to refer your Horizon BCBSNJ patients and/or send their laboratory testing samples (based on member plan benefits).</p> <p><span class="class-bold">How We’re Improving Access</span><br /> Effective <span class="class-bold">January 1, 2019</span>, our laboratory network will be as follows:</p> <ul style="list-style-type:none"> <li> <p><u>Horizon PPO Network</u></p> <p>If you are enrolled in a plan that uses the Horizon PPO Network (PPO, Indemnity, Horizon <em>MyWay</em>® and Federal Employee Program® [FEP®] plans) you will have<br /> in-network access to the following national laboratories:</p> <ul style="list-style-type:disc"> <li>BioReference Laboratories</li> <li>LabCorp</li> <li>Quest Diagnostics</li> </ul> </li> <li> <p><u>Horizon Managed Care Network</u></p> <p>If you are enrolled in a plan that uses the Horizon Managed Care Network¹ (Horizon HMO, Horizon Advantage EPO, OMNIASM Health Plans, Horizon Direct Access, Horizon POS, Horizon Medicare Advantage or NJ DIRECT plans), you will have in-network access to the following national laboratories:</p> <ul style="list-style-type:disc"> <li>LabCorp</li> <li>Quest Diagnostics</li> </ul> </li> <li> <p><u>Horizon NJ Health </u></p> <p>LabCorp will continue to be the exclusive in-network laboratory for Horizon NJ Health members.</p> </li> </ul> <p>This expansion continues Horizon BCBSNJ’s commitment to improving access to care, lowering overall costs and improving the member experience.</p> <p>You can help members reduce their out-of-pocket costs, and access the care and services they need by referring them to these in-network national laboratories. As a reminder, our networks include a number of participating laboratories that can provide a variety of specialized laboratory services. Please visit our <i><a href="https://doctorfinder.horizonblue.com/">Doctor &amp; Hospital Finder</a>&nbsp;</i>to locate participating laboratories.</p> <p><small><i>¹Pathology services provided in a hospital setting to members enrolled in Horizon BCBSNJ managed care plans by a practice that participates in the Horizon Managed Care Network are allowed as an exception to the above-described LabCorp/Quest Diagnostics&nbsp;network use requirements.</i></small></p> <p><small>LabCorp is the commonly used name for Laboratory Corporation of America Holdings®. Laboratory Corporation of America® is a registered mark of Laboratory Corporation of America Holdings. Federal Employee Program® and FEP® names are registered marks of the Blue Cross and Blue Shield Association NJ DIRECT is administered by Horizon Blue Cross Blue Shield of New Jersey, an independent licensee of the Blue Cross and Blue Shield Association. OMNIASM and Horizon <em>MyWay</em> are service marks of Horizon Blue Cross Blue Shield of New Jersey.</small></p> </div> Tue, 02 Jul 2019 05:55:21 +0000 horizonbcbsnj 4258 at https://www.horizonblue.com Romosozumab-aqqg (Evenity) https://www.horizonblue.com/node/4468 <span class="field field--name-title field--type-string field--label-hidden">Romosozumab-aqqg (Evenity)</span> <span class="field field--name-created field--type-created field--label-hidden">Mon, 07/01/2019 - 08:46</span> <div class="field field--name-field-medical-policy-type field--type-entity-reference field--label-above"> <div class="field__label">Medical policy type</div> <div class="field__item"><a href="/taxonomy/term/48" hreflang="en">New</a></div> </div> <div class="field field--name-field-third-party-url field--type-string field--label-above"> <div class="field__label">Third Party URL</div> <div class="field__item">https://services3.horizon-bcbsnj.com/hcm/MedPol2.nsf/MedicalPolicies/SSHH-BCZK7C</div> </div> Mon, 01 Jul 2019 12:46:31 +0000 horizonbcbsnj 4468 at https://www.horizonblue.com Medical Injectables Program Updates: August 2019 https://www.horizonblue.com/providers/news/news-legal-notices/medical-injectables-program-updates-august-2019 <span class="field field--name-title field--type-string field--label-hidden">Medical Injectables Program Updates: August 2019</span> <span class="field field--name-created field--type-created field--label-hidden">Mon, 07/01/2019 - 05:03</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>Please review the Medical Injectables Program (MIP) updates noted below.</p> <p><span class="class-bold">MEDICATIONS TO BE ADDED</span></p> <p>Effective<span class="class-bold"> </span><span class="class-bold">August 1, 2019</span>, additional injectable medications will be included as part of our MIP.</p> <p>Beginning with services to be provided on and after <span class="class-bold">August 1, 2019</span>, Magellan Rx Management will conduct medical necessity and appropriateness reviews (MNARs) for the additional injectable medications listed below which were included as part of the Center for Medicare &amp; Medicaid Services’ <a href="https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2019Downloads/R4306CP.pdf">Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes - July 2019 Update</a>.</p> <table border="0" cellpadding="7" cellspacing="0"> <tbody> <tr> <td><span class="class-bold">Brand Name</span></td> <td><span class="class-bold">Generic Name</span></td> <td><span class="class-bold">HCPCS</span></td> </tr> <tr> <td>Belrapzo</td> <td>bendamustine hydrochloride</td> <td>J9036</td> </tr> <tr> <td>Herceptin Hylecta</td> <td>trastuzumab-hyaluronidase-oysk</td> <td>J9356</td> </tr> <tr> <td>Herzuma</td> <td>trastuzumab-pkrb</td> <td>Q5113</td> </tr> <tr> <td>Ogiviri</td> <td>trastuzumab-dkst</td> <td>Q5114</td> </tr> <tr> <td>Ontruzant</td> <td>trastuzumab-dttb</td> <td>Q5112</td> </tr> <tr> <td>Truxima</td> <td>rituximab-abbs</td> <td>Q5115</td> </tr> </tbody> </table> <p><span class="class-bold">Coding for Rebinyn</span><span class="superscript">®</span></p> <p>Earlier this year <a href="/providers/news/news-legal-notices/medical-injectables-program-update-hemophilia-drugs-to-be-included">we announced</a> that effective <span class="class-bold">August 15, 2019</span>, Magellan Rx Management<span class="superscript">SM</span> (MRxM) will conduct medical necessity and appropriateness review (MNAR) for certain hemophilia drugs as part of our MIP.¹</p> <p>Based on Centers for Medicare &amp; Medicaid Services’ guidance, please use the HCPCS code noted below when submitting claims for Rebinyn (coagulation factor IX [recombinant], GlycoPEGylated).</p> <table border="0" cellpadding="7" cellspacing="0"> <tbody> <tr> <td><span class="class-bold">Brand Name</span></td> <td><span class="class-bold">Generic Name</span></td> <td><span class="class-bold">HCPCS</span></td> </tr> <tr> <td>Rebinyn<span class="superscript">®</span></td> <td>coagulation factor IX (recombinant), GlycoPEGylated</td> <td>J7203</td> </tr> </tbody> </table> <p>Review the full <a href="/sites/default/files/2019-06/MIP_Master_List.pdf"> list of injectable medications that require MNAR</a> as part of the MIP, or learn more about our <a href="/providers/products-programs/medical-injectables-program">Medical Injectables Program</a>.</p> <p><a name="_GoBack"></a></p> <p>If you have questions, please contact your Network Specialist.</p> <p>¹<span class="class-italic"> </span><span class="class-italic">As part of our MIP, Magellan Rx Management conducts MNARs for injectable medications administered in a freestanding or hospital-based dialysis center, an outpatient facility, a patient’s home or a physician’s office. Magellan Rx Management does not conduct MNARs</span><span class="class-italic"> for injectable medications administered during an inpatient stay, or in an Emergency Room or Observation Room setting.<br /> <br /> For medical Injectable services rendered in the patient’s home, call </span><span class="class-italic"><span class="class-bold">1-855-243-3321</span></span><span class="class-italic"> for participating Horizon Care@Home health care professionals to obtain pre-service determination.</span></p> <p>REBINYN<span class="superscript">®</span> is a registered trademark of Novo Nordisk A/S.</p> <p>Magellan Rx Management<span class="superscript">SM</span> is a service mark of Magellan Health, Inc<span class="class-italic">. </span>Magellan Rx Management is an independent company that supports Horizon Blue Cross Blue Shield of New Jersey in the administration of<span class="class-italic"> </span>conduct medical necessity and appropriateness review (MNAR) for certain medical injectable drugs. Magellan Rx Management is independent from and not associated with Horizon Blue Cross Blue Shield of New Jersey.</p> </div> Mon, 01 Jul 2019 09:03:22 +0000 horizonbcbsnj 4467 at https://www.horizonblue.com Changes to Management of the Horizon Behavioral Health Program https://www.horizonblue.com/brokers/news/broker-news/changes-to-management-of-horizon-behavioral-health-program <span class="field field--name-title field--type-string field--label-hidden">Changes to Management of the Horizon Behavioral Health Program</span> <span class="field field--name-created field--type-created field--label-hidden">Fri, 06/28/2019 - 05:16</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>June 28, 2019</p> <p>Applies to:<span class="class-bold"> All Markets</span></p> <p>Horizon Blue Cross Blue Shield of New Jersey will transition the administrative and clinical management of the Horizon Behavioral HealthSM Program – behavioral health services and benefits – from Beacon Health Options (formerly Value Options) to Horizon BCBSNJ internal operations.</p> <p>Horizon Medicare Advantage plans will change on or about <span class="class-bold">January 1, 2020.</span> All other fully insured and self-insured (Administrative Services Only [ASO]) plans will change on or about <span class="class-bold">April 1, 2020.</span></p> <p>Throughout this transition, members will have uninterrupted access to the behavioral health services they are entitled to under their plan. Horizon BCBSNJ’s plan benefits and services will not change and members will continue to have access to the same network of behavioral health providers. In addition, health care information will remain safeguarded to protect our members’ privacy.</p> <p>This change continues our commitment to providing better coordination of medical care and behavioral health care services when members access mental health and substance use disorder treatment. Care for the body and mind must be coordinated to help ensure the best outcomes. Our integrated strategy will help empower members to achieve their best physical health, mental and emotional wellbeing. Whether members and their families are dealing with everyday challenges or serious conditions, Horizon BCBSNJ will continue to be here to help them access the best overall care. This change will help provide a more connected, more complete approach to total wellness.</p> <p>Horizon BCBSNJ remains committed to working with health care professionals throughout the state to improve the quality of care while lowering the cost of care and improving the experience for our members facing mental health issues and substance use disorders.</p> <p>If you have questions, please contact your Horizon BCBSNJ sales executive or account manager.</p> </div> Fri, 28 Jun 2019 09:16:16 +0000 horizonbcbsnj 4472 at https://www.horizonblue.com Changes to Management of the Horizon Behavioral Health Program https://www.horizonblue.com/members/news/member-news/changes-to-management-of-horizon-behavioral-health-program <span class="field field--name-title field--type-string field--label-hidden">Changes to Management of the Horizon Behavioral Health Program</span> <span class="field field--name-created field--type-created field--label-hidden">Thu, 06/27/2019 - 08:30</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>Beginning on or about <span class="class-bold">January 1, 2020</span>, Horizon BCBSNJ will move the administrative and clinical management of the Horizon Behavioral Health℠ Program – behavioral health services and benefits – from Beacon Health Options (<em>formerly ValueOptions</em>) to Horizon BCBSNJ’s internal operations.</p> <ul> <li>Horizon Medicare Advantage plans will change on or about <span class="class-bold">January 1, 2020</span>.</li> <li>Horizon BCBSNJ fully insured and self-insured plans will change on or about <span class="class-bold">April 1, 2020</span></li> </ul> <p><span class="class-bold">What does this mean?</span></p> <p>Beginning in 2020, Horizon BCBSNJ will no longer use Beacon Health Options to manage the program. This change does not impact your plan benefits and services.</p> <ul> <li><span class="class-bold">You will continue to have access to behavioral health services according to your plan. Current benefits will not be changing. </span></li> <li><span class="class-bold">There will be no changes to the network of behavioral health care professionals that participate with your plan. </span></li> <li><span class="class-bold">You don’t need a new member ID card.</span></li> <li><span class="class-bold">You can still use the phone numbers that you currently use to access behavioral health care benefits and services. </span></li> <li><span class="class-bold">Your health care information will remain safeguarded to protect your privacy.</span></li> </ul> <p>Horizon BCBSNJ remains committed to working with health care professionals throughout the state to improve care for our members facing mental health issues and substance use disorders.</p> </div> Thu, 27 Jun 2019 12:30:14 +0000 horizonbcbsnj 4426 at https://www.horizonblue.com Navinet https://www.horizonblue.com/providers/resources/training/education/navinet <span class="field field--name-title field--type-string field--label-hidden">Navinet</span> <span class="field field--name-created field--type-created field--label-hidden">Wed, 06/26/2019 - 08:57</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><!--<p><a href="https://support.navinet.net/health-plans/horizon-bcbsnj/new-feature/referrals/enhanced-referrals" target="_blank">Navinet Information Demo</a></p>--><!--<style type="text/css">.embed-container { position: relative; padding-bottom: 56.25%; padding-top: 30px; height: 0; overflow: hidden; max-width: 100%; height: auto; } .embed-container iframe, .embed-container object, .embed-container embed { position: absolute; top: 0; left: 0; width: 100%; height: 100%; } </style>--> <p>&nbsp;</p> <div class="visible-lg visible-md visible-sm"><!--Video Script--> <div class="embed-container"><iframe align="middle" allowtransparency="true" frameborder="0" height="480" scrolling="no" src="https://player.piksel.com/a/q596580t" width="640"></iframe></div> <!-- Video 1 --><!-- Put this <div> anywhere in the <body> of your page where you want the widget to show up. --></div> <!--video embed--> <div class="visible-xs"> <div class="embed-container"><iframe align="middle" allowtransparency="true" frameborder="0" height="480" scrolling="no" src="https://player.piksel.com/a/q596580t" width="640"></iframe></div> <!-- Put this <div> anywhere in the <body> of your page where you want the widget to show up. --></div> </div> Wed, 26 Jun 2019 12:57:11 +0000 horizonbcbsnj 4466 at https://www.horizonblue.com Onasemnogene Abeparvovec (Zolgensma) https://www.horizonblue.com/node/4465 <span class="field field--name-title field--type-string field--label-hidden">Onasemnogene Abeparvovec (Zolgensma)</span> <span class="field field--name-created field--type-created field--label-hidden">Tue, 06/25/2019 - 13:43</span> <div class="field field--name-field-medical-policy-type field--type-entity-reference field--label-above"> <div class="field__label">Medical policy type</div> <div class="field__item"><a href="/taxonomy/term/48" hreflang="en">New</a></div> </div> <div class="field field--name-field-third-party-url field--type-string field--label-above"> <div class="field__label">Third Party URL</div> <div class="field__item">https://services3.horizon-bcbsnj.com/hcm/MedPol2.nsf/MedicalPolicies/SSHH-BCZJDN</div> </div> Tue, 25 Jun 2019 17:43:50 +0000 horizonbcbsnj 4465 at https://www.horizonblue.com Member ID Cards and Proof of Coverage Options Available Through App and Online https://www.horizonblue.com/brokers/news/broker-news/member-id-cards-and-proof-of-coverage-options-available-through-app-and-online <span class="field field--name-title field--type-string field--label-hidden">Member ID Cards and Proof of Coverage Options Available Through App and Online</span> <span class="field field--name-created field--type-created field--label-hidden">Tue, 06/25/2019 - 06:13</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p><span class="class-bold">June 17, 2019</span></p> <p><span class="class-bold">Applies to:</span> All Markets</p> <p>Members who need care but don't have their member ID handy can easily use the Horizon Blue app to access their card and show it to a health care professional.</p> <p>Using the app, members can display and/or print a copy of their member ID card – as well as order a permanent replacement. Members just need to register for the app, sign in, choose&nbsp;<span class="class-italic">ID Cards&nbsp;</span>and follow the instructions. To download the Horizon Blue app, members can text<span class="class-bold"> GetApp</span> to<span class="class-bold"> 422-272 </span>or download it at the App Store<span class="superscript">®</span> or Google Play™.</p> <p>Members can also access their member ID card when signed in.</p> <p>We encourage you to download and share our <a href="/sites/default/files/2019-06/MemberIDwithApp.pdf ">flyer </a> on this topic with your group and individual clients so they know about these convenient options available to them.</p> <p>If you have questions, please contact your Horizon BCBSNJ sales executive or account manager.</p> <p><small>The App Store<span class="superscript">®&nbsp;</span>is an online store and is a service mark of Apple, Inc. Google Play<span class="superscript">™&nbsp;</span>is a trademark of Google, Inc.There is no charge to download the Horizon Blue app, but wireless rates from your carrier may apply.</small></p> </div> Tue, 25 Jun 2019 10:13:44 +0000 horizonbcbsnj 4464 at https://www.horizonblue.com Reminder: Additional Member Plans to be Included as part of our Surgical and Implantable Device Management Program for Orthopedic Surgeries https://www.horizonblue.com/providers/news/news-legal-notices/reminder-additional-member-plans-to-be-included-as-part-of-our-surgical-and-implantable-device <span class="field field--name-title field--type-string field--label-hidden">Reminder: Additional Member Plans to be Included as part of our Surgical and Implantable Device Management Program for Orthopedic Surgeries</span> <span class="field field--name-created field--type-created field--label-hidden">Tue, 06/25/2019 - 05:37</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>As a reminder, beginning <span class="class-bold">July 15, 2019,</span> the Surgical and Implantable Device Management program for orthopedic services will also apply to members enrolled in Horizon BCBSNJ Medicare Advantage plans.</p> <p>Through this specialty utilization management program, which Horizon BCBSNJ collaborates with TurningPoint Healthcare Solutions LLC (TurningPoint), TurningPoint conducts Prior Authorization &amp; Medical Necessity Determination (PA/MND) reviews for certain orthopedic surgery services that are requested by participating and nonparticipating physicians when rendered in the following settings¹:</p> <ul> <li>Inpatient</li> <li>Outpatient</li> <li>Ambulatory Surgical Center</li> <li>Physician’s Office</li> </ul> <p>Initially, this program only applied to services provided to Horizon BCBSNJ members enrolled in fully insured plans/products and to those members in fully insured plans/products that include BlueCard® benefits for care received outside of Horizon BCBSNJ’s local service area²,³.</p> <p>Beginning July 1, 2019, TurningPoint will begin accepting PA/MND requests for orthopedic surgery services to be rendered on and after July 15, 2019 to members enrolled in Horizon BCBSNJ Medicare Advantage plans.</p> <p><a href="/providers/products-programs/surgical-and-implantable-device-management-program">View more</a> about this program, including a full listing of the procedures and <a href="/sites/default/files/2019-04/ORTHO%20Code_List%20TP.pdf">CPT® codes</a> that are subject to PA/MND review under this program. You can also review information about the PA/MND review process and medical policy guidelines TurningPoint uses to conduct their reviews.</p> <p><span class="class-bold">Questions?</span></p> <p>Horizon BCBSNJ values your participation in our network and the care you provide to our members. If you have any questions, call <span class="class-bold">1-833-436-4083</span> Monday through Friday between 8 a.m. and 5 p.m., Eastern Time.</p> <p><small>¹Services rendered in the observation setting and the Emergency Room (ER) are not reviewed by TurningPoint as part of this program. ²Horizon BCBSNJ members enrolled in plans that include BlueCard benefits who receive care outside of Horizon BCBSNJ’s service area which includes the State of New Jersey, contiguous counties in DE, NY and PA (as well as Lehigh County, PA).</small></p> <p><small>³To determine member eligibility and benefits, physicians can call the phone number on the back to the member’s ID card. For BlueCard benefit inquiries call 1-800-676-2583.</small></p> <p cpt="" style="font-size:x-small">NaviNet® is a registered trademark of NaviNet, Inc.<br /> TurningPoint Healthcare Solutions, LLC supports Horizon Blue Cross Blue Shield of New Jersey in the administration and utilization management review of certain surgical services that require an implantable device 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.</p> <p>&nbsp;</p> </div> Tue, 25 Jun 2019 09:37:02 +0000 horizonbcbsnj 4463 at https://www.horizonblue.com Conscious Sedation https://www.horizonblue.com/providers/policies-procedures/policies/reimbursement-policies-guidelines/conscious-sedation <span class="field field--name-title field--type-string field--label-hidden">Conscious Sedation</span> <span class="field field--name-created field--type-created field--label-hidden">Mon, 06/24/2019 - 09:16</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p><span class="class-bold">Reimbursement Policy:</span><br /> Conscious Sedation</p> <p><span class="class-bold">Effective Date:</span><br /> June 1, 2006</p> <p><span class="class-bold">Last Revised Date:</span><br /> June 13, 2017</p> <p><span class="class-bold">Purpose</span>:<br /> To provide guidelines for the reimbursement of conscious sedation</p> <p><span class="class-bold">Scope: </span><br /> All products are included, except</p> <ul> <li>Products where Horizon BCBSNJ is secondary to Medicare (e.g. Medigap)</li> <li>COB</li> </ul> <p>All Insured and Administrative Services Only (ASO) accounts are included.</p> <p><span class="class-bold">Policy:</span><br /> Procedure codes 99151, 99152, 99155, 99156, and G0500 are classified as medical codes. Only one (1) unit is considered for reimbursement per date of service.</p> <p>Procedure codes 99153 and 99157, also classified as medical codes, may be used to report additional units. Multiple units of these codes are considered for reimbursement.</p> <p>The CPT codes/nomenclature used in this policy are subject to revision and/or change by the American Medical Association. In the event of such changes, the policy will continue to be in force, albeit applied to the new or amended coding so issued until this policy is revised to reflect new/amended coding.</p> <p><span class="class-bold">Procedure: </span><br /> Horizon BCBSNJ shall reimburse for conscious sedation at the applicable Horizon BCBSNJ fee schedule.</p> <p>In instances where the provider is participating, based on member benefits, co-payment, coinsurance, and/or deductible shall apply.</p> <p>In instances where the provider is not participating, member liability shall be up to the provider’s charge.</p> <p><span class="class-bold">Limitations and Exclusions:</span><br /> While reimbursement is considered, payment determination is subject to, but not limited to:</p> <ul> <li>Group or Individual benefit</li> <li>Provider Participation Agreement</li> <li>Routine claim editing logic, including but not limited to incidental or mutually exclusive logic, and medical necessity</li> <li>Mandated or legislative required criteria will always supersede.</li> </ul> <p><span class="class-bold">History:</span><br /> 04/11/2016: Policy approved<br /> 06/13/2017: Replaced deleted codes 99143, 99144, 99145, 99148, 99149, 99150 with revised codes</p> <p>Policy003_v2.0_06132017</p> </div> Mon, 24 Jun 2019 13:16:58 +0000 horizonbcbsnj 4461 at https://www.horizonblue.com Reminder: Surgical and Implantable Device Program to Include Cardiac Services https://www.horizonblue.com/providers/news/news-legal-notices/reminder-surgical-and-implantable-device-program-to-include-cardiac-services <span class="field field--name-title field--type-string field--label-hidden">Reminder: Surgical and Implantable Device Program to Include Cardiac Services</span> <span class="field field--name-created field--type-created field--label-hidden">Mon, 06/24/2019 - 09:04</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>As a reminder, effective<span class="class-bold"> July 15, 2019,</span> Horizon BCBSNJ will expand our Surgical and Implantable Device Management Program, administered by TurningPoint Healthcare Solutions, LLC (TurningPoint), to include Prior Authorization &amp; Medical Necessity Determination (PA/MND) reviews for certain <span class="class-bold">cardiac services,</span> many of which may require the use of an implantable device.</p> <p>TurningPoint will conduct PA/MND reviews of certain cardiac services to:</p> <ul> <li>Determine medical necessity of the services to be provided</li> <li>Ensure appropriate conservative therapies are attempted prior to invasive procedures</li> <li>Help to ensure that the most appropriate surgery is performed in the most appropriate setting using the most appropriate device(s)</li> <li>Help to improve provider best practices</li> </ul> <p>TurningPoint will accept requests for PA/MND starting on <span class="class-bold">July 1, 2019,&nbsp;</span>for any in-scope cardiac procedures to be performed on or after<span class="class-bold"> July 15, 2019.</span></p> <p><span class="class-bold">Some of the most common cardiac surgical procedures subject to PA/MND review under this program include:</span></p> <table> <tbody> <tr> <td>Implantable Cardioverter Defibrillators</td> </tr> <tr> <td>Pacemaker (Single Chamber)</td> </tr> <tr> <td>Pacemaker (Dual Chamber)</td> </tr> <tr> <td>Pacemaker (Leadless)</td> </tr> <tr> <td>Stent (Angioplasty &amp; Endovascular)</td> </tr> <tr> <td>Stent (Drug Eluting)</td> </tr> </tbody> </table> <p><span class="class-bold">Places of service included in this program</span><br /> TurningPoint will conduct PA/MND reviews for services rendered in the following settings:</p> <ul> <li>Inpatient</li> <li>Outpatient</li> <li>Ambulatory Surgical Center</li> <li>Office setting</li> </ul> <p>TurningPoint will not conduct PA/MND reviews of services rendered in the Emergency Room or an observation setting.</p> <p><span class="class-bold">Members included in this program</span><br /> TurningPoint will conduct PA/MND reviews of services to be provided to members enrolled in Horizon BCBSNJ fully insured plans/products (including those fully insured plans/products plans that include BlueCard® benefits for care received outside of our local service area).¹ ²&nbsp;</p> <p>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.³</p> <p><span class="class-bold">Submitting a PA/MND request to TurningPoint</span><br /> There are three ways you can request a PA/MND for a cardiac service:</p> <ul> <li>Log on to NaviNet®,select <i> Horizon BCBSNJ</i> from the<i> My Health Plans menu,</i> and: <ul> <li>Mouse over&nbsp;<i>Referrals &amp; Authorization</i> and select <i>TurningPoint PA/MND Requests</i></li> <li>Select&nbsp;<i>Requests</i> within the TurningPoint menu bar or click the<i> Add Request</i> shortcut.</li> </ul> </li> </ul> <ul> <li>If you do not have access to NaviNet, you can submit a request via TurningPoint’s web portal at <span class="class-bold">myturningpoint-healthcare.com.</span> You must register to obtain access credentials by calling TurningPoint at <span class="class-bold"> 1-833-436-4083,</span> Monday through Friday between 8 a.m. and 5 p.m., Eastern Time.</li> <li>Call TurningPoint at&nbsp;<span class="class-bold">1-833-436-4083</span> during the hours noted above.</li> </ul> <p><a href="/providers/products-programs/surgical-and-implantable-device-management-program">Review the information</a> TurningPoint requires for a PA/MND request.</p> <p><span class="class-bold">Provider responsibilities</span><br /> <span class="class-bold">Physicians</span><br /> Physicians are responsible for requesting PA/MND review from TurningPoint.</p> <p>Although some member benefits do not require prior authorization for services rendered in an outpatient setting or a physician’s office, physicians are strongly encouraged to obtain a pre-service MND from TurningPoint&nbsp; prior&nbsp;to providing cardiac services included in this program to ensure that services will be considered medically necessary.</p> <p><span class="class-bold">Hospitals and Ambulatory Surgery Centers</span></p> <p>Rendering hospitals and ambulatory surgical centers are encouraged to call TurningPoint at&nbsp;<span class="class-bold">1-833-436-4083</span> to confirm that a PA/MND has been obtained.</p> <p>TurningPoint will provide authorization and pre-service PA/MND determination notifications to facilities if they made aware of the appropriate persons/departments to receive such notification. Please call TurningPoint at<span class="class-bold"> 1-833-436-4083</span> to provide contact information to receive PA/MND determination notifications.</p> <p>Cardiac services submitted on professional and facility claims that are reviewed by TurningPoint on a post-service basis and deemed not medically necessary will not be eligible for coverage or payment by Horizon BCBSNJ. Claims for impacted services will also be processed and reimbursed in a manner consistent with TurningPoint’s guidelines in regard to frequency rules and service maximums.</p> <p>Medical policy criteria and guidelines TurningPoint manages and maintains the<a href="/providers/products-programs/surgical-and-implantable-device-management-program"> medical policy criteria and guidelines</a> used to conduct PA/MND reviews as part of this program expansion.</p> <p><span class="class-bold">Program details and information</span><br /> Information about this program including the following program resources are available.</p> <ul> <li><a href="/sites/default/files/2019-06/FAQ_Surgical_Implantable_Cardiac.pdf">Surgical and Implantable Device Management Program for Cardiac Services Q&amp;A</a></li> <li><a href="/sites/default/files/2019-06/Cardiac_Surgical_Implantable_Code_List.pdf">Surgical and Implantable Device Management Program for Cardiac Services Procedure Code Listing</a></li> </ul> <p><span class="class-bold">Questions?</span></p> <p>If you have any questions, call TurningPoint at<span class="class-bold"> 1-833-436-4083.</span></p> <p><small>¹Horizon BCBSNJ members enrolled in plans that include BlueCard benefits who receive care outside of Horizon BCBSNJ’s service area which includes the State of New Jersey, contiguous counties in DE, NY and PA (as well as Lehigh County, PA).</small></p> <p><small>²You 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<span class="class-bold"> 1-800-676-2583.</span></small></p> <p><small>³ The back of a self-insured ASO member ID card will state, “Horizon BCBSNJ provides administrative services only and does not assume any financial risk for claims.” A fully insured member’s ID card will not have that message. Please always verify member benefits, as it may be possible that the most current ID card is not presented at the time of service.</small></p> <p><small>NaviNet® is a registered trademark of NaviNet, Inc.</small></p> <p><small>TurningPoint Healthcare Solutions, LLC supports Horizon Blue Cross Blue Shield of New Jersey in the administration and utilization management review of certain surgical services requiring implantable devices 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.</small></p> </div> Mon, 24 Jun 2019 13:04:59 +0000 horizonbcbsnj 4462 at https://www.horizonblue.com Implantable Device Management Program for Orthopedic Surgeries https://www.horizonblue.com/providers/news/news-legal-notices/implantable-device-management-program-for-orthopedic-surgeries <span class="field field--name-title field--type-string field--label-hidden">Implantable Device Management Program for Orthopedic Surgeries</span> <span class="field field--name-created field--type-created field--label-hidden">Mon, 06/24/2019 - 08:21</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>As a reminder, beginning July<span class="class-bold"> 15, 2019,</span> the Surgical and Implantable Device Management program for orthopedic services will also apply to members enrolled in Horizon BCBSNJ Medicare Advantage plans.</p> <p>Through this specialty utilization management program, which Horizon BCBSNJ collaborates with TurningPoint Healthcare Solutions LLC (TurningPoint), TurningPoint conducts Prior Authorization &amp; Medical Necessity Determination (PA/MND) reviews for certain orthopedic surgery services that are requested by participating and nonparticipating physicians when rendered in the following settings¹:</p> <ul> <li>Inpatient</li> <li>Outpatient</li> <li>Ambulatory Surgical Center</li> <li>Physician’s Office</li> </ul> <p>Initially, this program only applied to services provided to Horizon BCBSNJ members enrolled in fully insured plans/products and to those members in fully insured plans/products that include BlueCard® benefits for care received outside of Horizon BCBSNJ’s local service area²,³.</p> <p>Beginning July 1, 2019, TurningPoint will begin accepting PA/MND requests for orthopedic surgery services to be rendered on and after July 15, 2019 to members enrolled in Horizon BCBSNJ Medicare Advantage plans.</p> <p><a href="/providers/products-programs/surgical-and-implantable-device-management-program">View more</a> about this program,including a full listing of the procedures and <a href="/sites/default/files/2019-04/ORTHO%20Code_List%20TP.pdf">CPT® codes</a> that are subject to PA/MND review under this program. You can also review information about the PA/MND review process and medical policy guidelines TurningPoint uses to conduct their reviews.</p> <p><span class="class-bold">Questions?</span></p> <p>Horizon BCBSNJ values your participation in our network and the care you provide to our members. If you have any questions, call &lt;span class="class-bold"&gt;1-833-436-4083 &lt;/span&gt;Monday through Friday between 8 a.m. and 5 p.m., Eastern Time.</p> <p><small>¹Services rendered in the observation setting and the Emergency Room (ER) are not reviewed by TurningPoint as part of this program. ²Horizon BCBSNJ members enrolled in plans that include BlueCard benefits who receive care outside of Horizon BCBSNJ’s service area which includes the State of New Jersey, contiguous counties in DE, NY and PA (as well as Lehigh County, PA).</small></p> <p><small>³To determine member eligibility and benefits, physicians can call the phone number on the back to the member’s ID card. For BlueCard benefit inquiries call 1-800-676-2583.</small></p> <p><small>CPT® is a registered trademark of the American Medical Association.<br /> NaviNet® is a registered trademark of NaviNet, Inc.<br /> TurningPoint Healthcare Solutions, LLC supports Horizon Blue Cross Blue Shield of New Jersey in the administration and utilization management review of certain surgical services that require an implantable device 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.</small></p> </div> Mon, 24 Jun 2019 12:21:35 +0000 horizonbcbsnj 4460 at https://www.horizonblue.com Ultrasound Services Program Will Not Be Implemented https://www.horizonblue.com/providers/news/news-legal-notices/ultrasound-services-program-will-not-be-implemented <span class="field field--name-title field--type-string field--label-hidden">Ultrasound Services Program Will Not Be Implemented</span> <span class="field field--name-created field--type-created field--label-hidden">Mon, 06/24/2019 - 08:00</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>We <a href="/providers/news/news-legal-notices/ultrasound-services-program-delayed-until-further-notice">recently announced</a> that we were delaying the implementation of Medical Necessity Determination (MND) review for certain obstetrical and non-obstetrical ultrasound procedures until further notice.</p> <p class="class-bold">Horizon BCBSNJ will NOT implement this Ultrasound Services Program.</p> <p>If you have questions, please contact your Network Specialist, Ancillary Contracting Specialist or Hospital Network Specialist.</p> </div> Mon, 24 Jun 2019 12:00:00 +0000 horizonbcbsnj 4459 at https://www.horizonblue.com Quarterly Claim Editing Update: Third Quarter 2019 https://www.horizonblue.com/providers/news/news-legal-notices/quarterly-claim-editing-update-third-quarter-2019 <span class="field field--name-title field--type-string field--label-hidden">Quarterly Claim Editing Update: Third Quarter 2019</span> <span class="field field--name-created field--type-created field--label-hidden">Wed, 06/19/2019 - 15:37</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>On or about <strong>August 25, 2019</strong>, Horizon Blue Cross Blue Shield of New Jersey will implement an update to our claim editing rules and processes.</p> <p>We encourage you to review details of this update in our <a href="/sites/default/files/Q3_2019_Claim_Edits.pdf">Quarterly Claim Editing Update Report</a>.</p> <ul> <li>The changes noted in this <a href="/sites/default/files/Q3_2019_Claim_Edits.pdf">report</a> will be implemented on or about July 1, 2019.<br /> <br /> The effective date of the changes noted in this report will be July 1, 2019 (<i>unless otherwise specified in the report</i>). Changes noted in this report will apply to all claims finalized on and after our implementation date.<sup>1</sup></li> </ul> <p>Read more about our <a href="/providers/policies-procedures/policies/reimbursement-policies-guidelines/claim-editing-policies">Claim Editing Policies</a></p> <p>If you have questions, call a Physician Services representative at <strong><a href="tel: 1-800-624-1110">1-800-624-1110</a></strong> or an Institutional Services representative at <strong><a href="tel:1-888-666-2535">1-888-666-2535</a></strong>, Monday through Friday, between 8 a.m. and 5 p.m., Eastern Time.</p> <p><i><sup>1</sup>Claims finalized before this update is implemented will not be adjusted following the implementation for the sole purpose of ensuring conformity with these claim editing rules. If a claim originally finalized before the implementation is adjusted after the implementation for other reasons, the claim editing rules noted here will be applied.</i></p> <hr /> <p><strong>Clear Claim Connection™</strong></p> <p>Participating physicians, other health care professionals and facilities can review how updated claim editing rules impact reimbursement for certain code combinations by using the Clear Claim Connection available via NaviNet®.</p> <p>To access Clear Claim Connection, log in to NaviNet.net and:</p> <ul> <li>Select Horizon BCBSNJ from the My Health Plans menu.</li> <li>Mouse over Claim Management.</li> <li>Click Clear Claim Connection.</li> </ul> <p>NaviNet® is a registered trademark of NaviNet, Inc.</p> </div> Wed, 19 Jun 2019 19:37:17 +0000 horizonbcbsnj 4458 at https://www.horizonblue.com