Home Feed https://www.horizonblue.com/rss/home/feed en Medicare Advantage Claim Editing Updates for LCDs https://www.horizonblue.com/providers/news/news-legal-notices/medicare-advantage-claim-editing-updates-for-lcds <span class="field field--name-title field--type-string field--label-hidden">Medicare Advantage Claim Editing Updates for LCDs</span> <span class="field field--name-created field--type-created field--label-hidden">Thu, 08/09/2018 - 10:25</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>Effective <strong>September 1, 2018</strong>, Horizon Blue Cross Blue Shield of New Jersey will implement updates to our claim editing rules and processes to help ensure that claims for members enrolled in our Medicare Advantage (MA) plans are processed according to Centers for Medicare &amp; Medicaid Services (CMS) guidelines.</p> <p>Beginning on September 1, 2018, Horizon BCBSNJ will process claims submitted for services provided on and after September 1, 2018 to Horizon BCBSNJ members in MA plans following the guidelines set forth in the Local Coverage Determinations (LCDs) listed below.</p> <p>You can review the details of these LCDs that may impact claims for services and/or supplies you provide to your patients enrolled in our MA plans. See below for instructions to access details through the CMS’ <a href="https://www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx">Medicare Coverage Database</a>.</p> <table> <thead> <tr> <td><strong>LCD Title</strong></td> <td><strong>LCD Document ID</strong></td> </tr> </thead> <tbody> <tr> <td>Non-Vascular Extremity Ultrasound</td> <td>L35409</td> </tr> <tr> <td>Oximetry Services</td> <td>L35434</td> </tr> <tr> <td>Repetitive Transcranial Magnetic Stimulation(TMS) in Adults with Treatment Resistant Major Depressive Disorder</td> <td>L34998</td> </tr> </tbody> </table> <p>Horizon BCBSNJ is implementing claim edits related to the LCDs noted above as part of our larger effort to implement all National Coverage Determination (NCD) and LCD guidelines for MA plans. This was previously announced on <a href="https://www.horizonblue.com/providers/news/news-legal-notices/medicare-advantage-claim-editing-updates-to-be-implemented-ncds-and-lcds">November 7, 2016</a>, <a href="https://www.horizonblue.com/providers/news/news-legal-notices/medicare-advantage-claim-editing-updates-to-be-implemented-ncds-and-lcds-0">May 24, 2017</a> and <a href="https://www.horizonblue.com/providers/news/news-legal-notices/medicare-advantage-claim-editing-updates-to-be-implemented-lcds-and-ncds">March 7, 2018</a>. Impacted health care professionals will be notified of any additional edits that will be implemented.</p> <p>Any member liability for services will be noted on the Explanation of Payment (EOP) and Explanation of Benefits (EOB) statements generated upon finalization of claims.</p> <p>If you have questions, call Physician Services at <strong>1-800-624-1110</strong> or Institutional Services at <strong>1-888-666-2535</strong>, Monday through Friday, between 8 a.m. and 5 p.m., Eastern Time.</p> <hr /> <p><strong>Medicare Coverage Database (MCD)</strong></p> <p>We encourage you to review LCD details within the <a href="https://www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx">Medicare Coverage Database</a>. Follow the instructions below to access this information.</p> <p><strong>To Access LCD information</strong></p> <ol> <li>Access the <a href="https://www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx">Medicare Coverage Database</a>.</li> <li>Within the <em>Quick Search</em> section, enter the <em>Document ID</em> and click <em>Search By ID.</em></li> <li>Enter a service date in the <em>LCD Effective Date Search</em> and click <em>Search. </em></li> <li>Scroll down and click the LCD title in question.</li> <li>Review the LCD information that is displayed.</li> </ol> </div> Thu, 09 Aug 2018 14:25:00 +0000 horizonbcbsnj 3984 at https://www.horizonblue.com Study: Horizon BCBSNJ’s Work to Combat Opioid Abuse Makes It a National Leader https://www.horizonblue.com/employers/news/employer-news/study-horizon-bcbsnj-s-work-to-combat-opioid-abuse-makes-it-a-national-leader <span class="field field--name-title field--type-string field--label-hidden">Study: Horizon BCBSNJ’s Work to Combat Opioid Abuse Makes It a National Leader</span> <span class="field field--name-created field--type-created field--label-hidden">Wed, 08/01/2018 - 06:39</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>Horizon Blue Cross Blue Shield of New Jersey recently released a <a href="https://horizonviewpoints.com/study-horizons-work-to-combat-opioid-abuse-make-it-a-national-leader">report</a> demonstrating that the Company is a national leader when it comes to preventing, combating and treating opioid abuse. The Company reported that the programs it developed over the past several years collaborating with prescribers, pharmacies and patients spurred a dramatic reduction in the number of opioid prescriptions dispensed between 2013 and 2017 and the highest rate of compliance with CDC-recommended dose and duration guidelines among all Blue Cross and/or Blue Shield Plans nationally. The Company also reported a 350 percent increase in spending to treat opioid use disorder (OUD) during that time period, underscoring its commitment to helping members get the care they need.</p> <p>The announcement comes on the heels of a <a href="http://www.njspotlight.com/stories/18/06/21/interactive-map-where-opioids-are-exacting-the-highest-death-toll-in-new-jersey/">report</a> citing data from the New Jersey Attorney General’s Office indicating that the state is on a pace to reach or exceed 3,000 opioid-related deaths by the end of the year, which would represent an increase of one-third over 2016.</p> <p>Earlier this year, the Company announced that over the next five years it would invest $125 million it expects in refunds resulting from federal tax reform in significant initiatives that will drive improvements in health care in several areas, including behavioral health, substance abuse prevention and addiction and recovery. The Company launched its first program to stem prescription drug abuse in 1999.</p> <p>“While the results are encouraging, we are faced with daily reminders that fully understanding and combating this public health crisis requires greater collaboration and engagement at virtually every level and Horizon is committed to that goal,” said Kevin P. Conlin, Chairman, CEO and President of Horizon BCBSNJ. “Horizon is devoting a substantial part of the federal tax refund it is getting to increase prevention and treatment, expand community outreach and intensify our multi-faceted, long-term strategy to help our members stay or become addiction-free. We are determined to continue to be a national leader when it comes to winning the fight against opioids.”</p> <p>The report, examining four years of medical and prescription claim data, also found:</p> <ul> <li><em>Horizon BCBSNJ commercially insured members filling at least one opioid prescription annually dropped by 28 percent, bettering the 25 percent reduction <a href="https://www.bcbs.com/the-health-of-america/reports/the-opioid-epidemic-america-update?utm_source=bcbscom&utm_medium=page&utm_content=&utm_campaign=HoA-opioidleadership">reported</a> nationally by all Blue Cross and/or Blue Shield Plans over the same period.</em></li> <li><em>Sixty-two percent of Horizon BCBSNJ commercially insured members’ cumulative opioid use in 2017 was within the CDC-recommended dose and duration guidelines up from up from 55 percent in 2013 – the highest nationally among all Blue Cross and/or Blue Shield Plans.</em></li> <li><em>In 2016, OUD among commercially insured members peaked with slightly more than seven in 1,000 members diagnosed. This diagnosis rate remained stable in 2017.</em></li> </ul> <p>“It takes a comprehensive, integrated strategy to tackle an epidemic as complex as opioid addiction,” said Allen Karp, Executive Vice President for Healthcare Management and Transformation for Horizon BCBSNJ. “That’s why Horizon’s response to the opioid crisis is far-reaching and encompasses three key areas: Education and Prevention, Treatment and Recovery, and Community Outreach. We are increasing our investment and building strategic, collaborative partnerships in every area to help our members.”</p> <p>Increased treatment and recovery are a major component of Horizon BCBSNJ’s multi-faceted efforts. The Company has:</p> <ul> <li>Piloted programs funding recovery and peer support specialists in hospital Emergency Rooms to connect patients with substance abuse problems to treatment;</li> <li>Developed an innovative episode of care program for Substance Use Disorders (SUDs); and</li> <li>Expanded access to behavioral health and SUD providers.</li> </ul> <p>Furthering its longstanding commitment to combat New Jersey’s opioid crisis, in November 2017 Horizon BCBSNJ signed on to Shatterproof’s national coalition of 16 health insurance companies agreeing to adopt eight “National Principles of Care” for the treatment of addiction that will improve outcomes and save lives.</p> <p>“By leveraging best-practice education and preventive interventions that target at-risk members and prescribers, Horizon has been able to identify, intervene and prevent the abuse of opioids. We use advanced analytics to better understand what is happening and to stop or prevent abuse,” said Dr. Tom Graf, Chief Medical Officer for Horizon BCBSNJ. These programs include:</p> <ul> <li><b>The Opioid Alert Program</b>, in which members who meet high thresholds of morphine equivalent dose of opioids are identified and are referred to Horizon BCBSNJ’s behavioral health or case management program for intervention when appropriate.</li> <li><b>Pharmacy Lock-in Program</b>, in which members are identified as high-risk for abuse based on the number of duplicate fills for opioid prescriptions at multiple pharmacies, and limits those identified to filling their prescriptions at a single pharmacy. In 2016 alone, Horizon BCBSNJ reached out to 12,000 Medicaid members through this program to reduce opioid use prescriptions by 37 percent.</li> <li><b>Prescriber Initiatives</b>. The program focuses on educating prescribers on how to reduce high-risk behaviors, reduce morphine equivalent dose, access a prescription monitoring program database and identify high-risk member behaviors.</li> </ul> <p>Horizon BCBSNJ has also launched a significant public outreach and engagement program aimed at bolstering educational efforts. This has involved:</p> <ul> <li>The development with Rutgers University of an opioids toolkit that has been used to help community-based organizations raise opioids awareness including among more than 3,000 middle school- and high school-age children in New Jersey;</li> <li>The award-winning Knock Out Opioid Abuse Town Hall series developed with the Partnership for A Drug Free New Jersey. Beginning in April 2017, the 21 town halls brought together more than 13,000 New Jersey residents in every county and provided them with a comprehensive understanding of the causes and effects of the opioid epidemic. The events included participation from county prosecutors, state legislators, and doctors and professionals from the prevention, treatment and recovery fields. </li> <li>The establishment of a co-branded partnership with Walgreens for Safe Med Disposal kiosks to increase opportunities to safely remove unused opioids from the community.</li> </ul></div> Wed, 01 Aug 2018 10:39:33 +0000 horizonbcbsnj 3981 at https://www.horizonblue.com Arthroscopy for Treatment of Knee Derangement https://www.horizonblue.com/node/3980 <span class="field field--name-title field--type-string field--label-hidden">Arthroscopy for Treatment of Knee Derangement</span> <span class="field field--name-created field--type-created field--label-hidden">Wed, 08/01/2018 - 05:31</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/DDIL-AWLLN7</div> </div> Wed, 01 Aug 2018 09:31:48 +0000 horizonbcbsnj 3980 at https://www.horizonblue.com Quarterly Update to Injectable Medication Fee Schedule: Q4 2018 https://www.horizonblue.com/providers/news/news-legal-notices/quarterly-update-to-injectable-medication-fee-schedule-q4-2018 <span class="field field--name-title field--type-string field--label-hidden">Quarterly Update to Injectable Medication Fee Schedule: Q4 2018</span> <span class="field field--name-created field--type-created field--label-hidden">Tue, 07/31/2018 - 11:40</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>Horizon Blue Cross Blue Shield of New Jersey will update our fee schedule for injectable medications on <strong>November </strong><strong>1, 2018</strong>.</p> <p>Effective <strong>November 1</strong><strong>, 2018</strong>, the fees for the injectable medications listed in the table below will decrease.</p> <p>We update our injectable medication fee schedule each quarter. The majority of changes made each quarter reflect industry-wide changes to the Average Sales Price (ASP) or the Average Wholesale Price (AWP) of an injectable medication. The changes noted in the table below identify decreases in injectable medication fees that do not reflect industry-wide changes in the ASP or AWP.</p> <table> <tbody> <tr> <td><strong>Code</strong></td> <td><strong>Dose</strong></td> <td><strong>Final Rate</strong></td> <td><strong>Prior Rate</strong></td> </tr> <tr> <td>90281</td> <td>2 ml</td> <td>$83.50</td> <td>$84.18</td> </tr> <tr> <td>J0178</td> <td>1 mg</td> <td>$987.90</td> <td>$988.96</td> </tr> <tr> <td>J1447</td> <td>1 mcg</td> <td>$0.81</td> <td>$0.83</td> </tr> <tr> <td>J1556</td> <td>500 mg</td> <td>$38.25</td> <td>$41.58</td> </tr> <tr> <td>J1568</td> <td>500 mg</td> <td>$35.97</td> <td>$44.92</td> </tr> <tr> <td>J1572</td> <td>500 mg</td> <td>$39.14</td> <td>$41.45</td> </tr> <tr> <td>J1627</td> <td>0.1 mg</td> <td>$3.89</td> <td>$4.54</td> </tr> <tr> <td>J2503</td> <td>0.3 mg</td> <td>$827.23</td> <td>$829.89</td> </tr> <tr> <td>J9023</td> <td>10 mg</td> <td>$77.59</td> <td>$77.63</td> </tr> <tr> <td>J9043</td> <td>1 mg</td> <td>$162.50</td> <td>$162.75</td> </tr> <tr> <td>J9228</td> <td>1 mg</td> <td>$142.18</td> <td>$142.32</td> </tr> <tr> <td>J9271</td> <td>1 mg</td> <td>$47.20</td> <td>$47.33</td> </tr> <tr> <td>Q2043</td> <td>Per infusion<br /> (minimum 50 million cells)</td> <td>$39,573.55</td> <td>$40,643.41</td> </tr> <tr> <td>Q5101</td> <td>1 mcg</td> <td>$0.86</td> <td>$0.89</td> </tr> </tbody> </table> <p>Claims processed on and after <strong>November </strong><strong>1, 2018</strong> that include these injectable medications will be reimbursed based on our revised fee schedule information. Horizon BCBSNJ reserves the right to adjust claims for services provided on and after November 1, 2018<strong> </strong>that are not reimbursed according to this updated information.</p> <p><a href="http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Part-B-Drugs/McrPartBDrugAvgSalesPrice/index.html">ASP information for Medicare Part B drugs is posted</a> by the Centers for Medicare &amp; Medicaid Services on the first day of the quarter. AWP information, based on data obtained from manufacturers, distributors and other suppliers, is available from a variety of commercial sources.</p> <hr /> <p><strong><em>Fee Schedule Inquiry</em></strong><strong> Tool </strong></p> <p>The complete injectable medication fee schedule information is available on our <em>Fee Schedule Inquiry</em> tool. Changes to our injectable medication fee schedule information are accessible on and after the effective date of a quarterly update.</p> <p>To access, log into <strong>NaviNet.net</strong>, select <em>Horizon BCBSNJ</em> from the <em>My Health Plans</em> menu and:</p> <ul> <li>Mouse over <em>Claim Management</em></li> <li>Select <em>Fee Request Inquiry</em></li> </ul> <p>To view allowances for specific injectable medications or other services:</p> <ul> <li>Select your <em>Billing Provider</em> number, <em>County</em> and <em>Specialty</em></li> <li>Enter the desired CPT® and/or HCPCS codes</li> <li>Select <em>Submit</em></li> </ul> <p>CPT® is a registered mark of the American Medical Association.</p> </div> Tue, 31 Jul 2018 15:40:03 +0000 horizonbcbsnj 3979 at https://www.horizonblue.com Autografts and Allografts in the Treatment of Focal Articular Cartilage Lesions https://www.horizonblue.com/node/3978 <span class="field field--name-title field--type-string field--label-hidden">Autografts and Allografts in the Treatment of Focal Articular Cartilage Lesions</span> <span class="field field--name-created field--type-created field--label-hidden">Mon, 07/30/2018 - 13:20</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/TKEN-6RP5D3</div> </div> Mon, 30 Jul 2018 17:20:32 +0000 horizonbcbsnj 3978 at https://www.horizonblue.com Surgical and Implantable Device Management Program to be Implemented https://www.horizonblue.com/providers/news/news-legal-notices/surgical-and-implantable-device-management-program-to-be-implemented <span class="field field--name-title field--type-string field--label-hidden">Surgical and Implantable Device Management Program to be Implemented</span> <span class="field field--name-created field--type-created field--label-hidden">Mon, 07/30/2018 - 07:27</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>Beginning <span class="class-bold">November 1, 2018,</span> Horizon Blue Cross Blue Shield of New Jersey will implement a new specialty utilization management program in collaboration with <span class="class-bold">TurningPoint Healthcare Solutions, LLC (TurningPoint)</span> for certain orthopedic surgeries, many of which may require the use of an implantable device. Through Horizon BCBSNJ’s Surgical and Implantable Device Management Program, TurningPoint will conduct Prior Authorization &amp; Medical Necessity Determination (PA/MND) reviews for certain orthopedic surgery services that are requested by participating and nonparticipating physicians rendered in the following settings<span>1</span>:</p> <ul> <li>Inpatient</li> <li>Outpatient</li> <li>Ambulatory Surgical Center</li> <li>Physician’s Office</li> </ul> <p>This program applies only to Horizon BCBSNJ members enrolled in fully insured plans/products and to Horizon BCBSNJ members enrolled in fully insured plans/products that include BlueCard® benefits for care received outside of Horizon BCBSNJ’s local service area<span>2</span>.</p> <p><span class="class-bold">TurningPoint will accept requests for PA/MNDs starting on October 22, 2018 for any in-scope orthopedic surgical procedure to be performed on or after November 1, 2018.</span></p> <p><span class="class-bold">Some of the most common procedures subject to PA/MND review under this program include:</span></p> <table> <tbody> <tr> <td><span class="class-bold">Joint Reconstructive &amp; Fusion Surgeries</span><br /> <em>(Including all associated revision surgeries)</em></td> </tr> <tr> <td> <ul> <li>Knee Arthroplasty</li> <li>Hip Arthroplasty</li> <li>Shoulder Arthroplasty</li> <li>Elbow Arthroplasty</li> <li>Ankle Arthroplasty</li> <li>Wrist Arthroplasty</li> <li>Hip Resurfacing</li> <li>Shoulder Fusion</li> <li>Elbow Fusion</li> <li>Ankle Fusion</li> <li>Wrist Fusion</li> </ul> </td> </tr> </tbody> </table> <p>&nbsp;</p> <table> <tbody> <tr> <td><span class="class-bold">Sports Medicine Surgeries</span></td> </tr> <tr> <td> <ul> <li>ACL Repair</li> <li>Acromioplasty &amp; Rotator Cuff Repair</li> <li>Femoroacetabular Arthroscopy</li> <li>Knee Arthroscopy</li> <li>Hip Arthroscopy</li> <li>Meniscal Repair (with or w/o Allograft)</li> <li>Osteochondral Defect Repair</li> </ul> </td> </tr> </tbody> </table> <p><a href="/turningpoint">View more</a> information about this new program, including a full listing of the procedures and CPT<span>®</span> codes that are subject to PA/MND review under this program.</p> <p><span class="class-bold">PA and Pre-Service MND Review</span></p> <p>Through the Surgical and Implantable Device Management Program, TurningPoint will conduct PA/MND review for orthopedic services and any related device to:</p> <ul> <li>Determine medical necessity</li> <li>Ensure appropriate conservative therapies are attempted prior to invasive procedures</li> <li>Ensure the most appropriate surgery is performed</li> <li>Ensure the right device is selected for the right patient</li> <li>Ensure the procedure is performed in the right setting</li> <li>Improve provider best practices</li> </ul> <p>Physicians must obtain PA for services rendered in the inpatient setting and for members whose benefits<span3< span=""> also require PA for services rendered in an outpatient setting and in the physician’s office.</span3<></p> <p>For members whose benefits do not require PA for services rendered in an outpatient setting or in the physician’s office, physicians are strongly encouraged to obtain a pre-service MND from TurningPoint prior to the surgery to ensure that services will be considered medically necessary and that coverage for the procedure will be provided. Services deemed not medically necessary when claims are received or reviewed may not be eligible for coverage or payment by Horizon BCBSNJ.</p> <p>Rendering hospitals and ambulatory surgical centers are responsible for confirming that an approved PA or pre-service MND has been obtained.</p> <ul> <li>Beginning <span class="class-bold">October 22, 2018,</span> you may log on to <a href="http://www.navinet.net/">NaviNet<span>®</span></a> to confirm the status of a PA/MND request.</li> <li>If you do not have access to NaviNet, you can confirm the status of a PA/MND request using TurningPoint’s web portal at <a href="https://www.myturningpoint-healthcare.com">https://www.myturningpoint-healthcare.com</a>. To register for access to TurningPoint’s web portal, call TurningPoint at <span class="class-bold">1-833-436-4083</span>, Monday through Friday, between 8 a.m. and 5 p.m., Eastern Time (ET).</li> <li>You may also call TurningPoint at <span class="class-bold">1-833-436-4083</span> to confirm the status of a PA/MND.</li> </ul> <p>If an out-of-network co-surgeon or assistant surgeon will be participating in the surgical procedure, it is the referring/rendering physician’s responsibility to notify TurningPoint at the time of the PA/MND request.</p> <p><span class="class-bold">How to Obtain PA/MND for Orthopedic Services</span></p> <ul> <li>Beginning <span class="class-bold">October 22, 2018</span>, a physician may log on to <a href="http://www.navinet.net/">NaviNet<span>®</span></a> to submit a request.</li> <li>Practices that do not have access to NaviNet can submit a request via TurningPoint’s web portal at https://www.myturningpoint-healthcare.com. 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., ET.</li> <li>You may also call TurningPoint at <span class="class-bold">1-833-436-4083</span> to submit PA/MND requests.</li> </ul> <p>TurningPoint must be provided with:</p> <ul> <li>The member’s: <p style="margin-left:15px;">− Horizon BCBSNJ ID number</p> <p style="margin-left:15px;">− First and last names</p> <p style="margin-left:15px;">− Date of birth</p> </li> <li>The rendering, referring or ordering physician’s: <p style="margin-left:15px;">− First and last names</p> <p style="margin-left:15px;">− National Provider Identifier (NPI)</p> <p style="margin-left:15px;">− Tax Identification Number (TIN)</p> <p style="margin-left:15px;">− Fax number</p> <p style="margin-left:15px;">− The above information should also be provided for any co-surgeon or assistant surgeon deemed necessary to perform the requested procedure(s)</p> </li> <li>The rendering facility’s: <p style="margin-left:15px;">− Name</p> <p style="margin-left:15px;">− NPI</p> <p style="margin-left:15px;">− TIN</p> <p style="margin-left:15px;">− Street address</p> <p style="margin-left:15px;">− Fax number</p> </li> <li>CPT codes and diagnosis codes</li> <li>Place of service</li> <li>All relevant clinical notes, imaging/X-ray reports and any anticipated implant, technology or hardware to be used.</li> </ul> <p>TurningPoint will use this information to make determinations for PA/MND requests and to perform claim reviews.</p> <p><span class="class-bold">Medical Policy Criteria and Guidelines</span></p> <p>Physicians and facilities can call TurningPoint at <span class="class-bold">1-833-436-4083</span> to request the medical policy criteria and guidelines TurningPoint will use to conduct PA/MND reviews. The medical policy criteria and guidelines will be effective <span class="class-bold">November 1, 2018</span>. TurningPoint’s medical policy criteria and guidelines pertain only to Horizon BCBSNJ fully insured members.</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., ET.</p> <p><small>¹ Services rendered in the observation setting and the Emergency Room (ER) are excluded.<br /> ² Horizon BCBSNJ members enrolled in plans that include BlueCard benefits who receive care outside of&nbsp;Horizon BCBSNJ’s service area which includes&nbsp;the State of New Jersey,&nbsp;contiguous counties in DE, NY and PA (as well as Lehigh County, PA).<br /> ³ To 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 <span class="class-bold">1-800-676-2583.</span></small></p> <p><small>CPT<span>®</span> is a registered trademark of the American Medical Association.<br /> NaviNet<span>®</span> is a registered trademark of NaviNet, Inc.<br /> TurningPoint Healthcare Solutions, LLC&nbsp;supports Horizon Blue Cross Blue Shield of New Jersey in the administration and utilization management review of certain orthopedic surgical services for coverage.&nbsp;TurningPoint Healthcare Solutions, LLC&nbsp;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, 30 Jul 2018 11:27:34 +0000 horizonbcbsnj 3977 at https://www.horizonblue.com NJ Individual Mandate https://www.horizonblue.com/members/education-center/nj-individual-mandate <span class="field field--name-title field--type-string field--label-hidden">NJ Individual Mandate</span> <span class="field field--name-created field--type-created field--label-hidden">Mon, 07/30/2018 - 04:31</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>Under a new state law, residents of New Jersey must have health insurance beginning January 1, 2019, or pay a penalty. Horizon BCBSNJ offers different plans so that you can get the coverage you need and avoid paying a penalty.</p> <p>New Jersey created this mandate because Congress repealed the penalties of the individual mandate of the Affordable Care Act (ACA), effective December 31, 2018, effectively ending the federal requirement that all individuals have health insurance.</p> <p>New Jersey’s mandate, which mirrors the federal requirement, includes an annual penalty of 2.5 percent of a household’s income or a per-person charge — whichever is higher. The maximum penalty based on a per-person charge will be $2,085.</p> <p>Individuals who purchase coverage directly from an insurance company or are covered under a group health plan comply with this mandate.</p> <p>A hardship exception for individuals who cannot afford coverage will be determined by the state treasurer.</p> <p><span class="class-bold">Do you want to buy health insurance?</span></p> <p>Individuals can buy health insurance between November 1 and December 15, during the Open Enrollment Period. Certain life events, such as the loss of a job or a move to another state, may make you eligible to buy insurance under a Special Enrollment Period, which is a 60-day window around the life event.</p> <p><a href="http://www.HorizonBlue.com/shop">Shop Horizon BCBSNJ medical plans. </a></p> </div> Mon, 30 Jul 2018 08:31:29 +0000 horizonbcbsnj 3976 at https://www.horizonblue.com 3-D Mammography Preventive Service Mandate https://www.horizonblue.com/brokers/news/broker-news/3-d-mammography-preventive-service-mandate <span class="field field--name-title field--type-string field--label-hidden">3-D Mammography Preventive Service Mandate</span> <span class="field field--name-created field--type-created field--label-hidden">Mon, 07/30/2018 - 03:57</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">July 26, 2018</span></p> <p><span class="class-bold">Applies to:</span> All commercial markets</p> <p>On January 16, 2018, the state of New Jersey enacted a new benefit mandate that requires health insurance coverage without cost sharing for digital tomosynthesis (three-dimensional or 3-D mammography) to detect or screen for breast cancer in women age 40 years and older. This mandate is effective for fully insured health plans and the State Health Benefits Program issued or renewed on or after August 1, 2018. Self-funded health plans can choose to offer this mandated benefit.</p> <p>Digital tomosynthesis creates a three-dimensional picture of the breast using several low-dose X-ray images from different angles as the scanner moves in an arc around the breast. Conventional mammography produces one image of overlapping tissue. The difference between the images produced by tomosynthesis and conventional mammography has been described as being similar to a ball (3-D) versus a circle (flat).</p> <p>One preventive 3-D mammography and one preventive conventional mammography are covered during each benefit year. However, if a mammography is provided for diagnostic purposes in women of any age, then cost sharing may apply.</p> <p>Self-funded groups have the option to participate with this mandate. If your self-funded group client opts into the mandate, its employees will receive the full coverage benefit of the mandate. If your self-funded group client opts out of this mandate, its employees will be covered, where applicable, by the federal Affordable Care Act, which only covers a conventional mammogram.</p> <p>If you have questions, please contact your Horizon BCBSNJ sales executive or account manager.</p> </div> Mon, 30 Jul 2018 07:57:17 +0000 horizonbcbsnj 3955 at https://www.horizonblue.com 3-D Mammography Preventive Service Mandate https://www.horizonblue.com/employers/news/employer-news/3-d-mammography-preventive-service-mandate <span class="field field--name-title field--type-string field--label-hidden">3-D Mammography Preventive Service Mandate</span> <span class="field field--name-created field--type-created field--label-hidden">Mon, 07/30/2018 - 03:42</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">July 26, 2018</span></p> <p>On January 16, 2018, the state of New Jersey enacted a new benefit mandate that requires health insurance coverage without cost sharing for digital tomosynthesis (three-dimensional or 3-D mammography) to detect or screen for breast cancer in women age 40 years and older. This new mandate is effective for fully insured plans and the State Health Benefits Program issued or renewed on or after August 1, 2018.</p> <p>Digital tomosynthesis creates a three-dimensional picture of the breast using several low-dose X-ray images from different angles as the scanner moves in an arc around the breast. Conventional mammography produces one image of overlapping tissue. The difference between the images produced by tomosynthesis and conventional mammography has been described as being similar to a ball (3-D) versus a circle (flat).</p> <p>One preventive 3-D mammography and one preventive conventional mammography are covered during each benefit year. However, if a mammography is provided for diagnostic purposes in women of any age, then cost sharing may apply.</p> </div> Mon, 30 Jul 2018 07:42:31 +0000 horizonbcbsnj 3974 at https://www.horizonblue.com Announcing an Improved Home Delivery Website for Horizon Pharmacy Members https://www.horizonblue.com/employers/news/employer-news/announcing-an-improved-home-delivery-website-for-horizon-pharmacy-members <span class="field field--name-title field--type-string field--label-hidden">Announcing an Improved Home Delivery Website for Horizon Pharmacy Members </span> <span class="field field--name-created field--type-created field--label-hidden">Mon, 07/30/2018 - 03:40</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">July 25, 2018</span></p> <p>Members enrolled in Horizon Blue Cross Blue Shield of New Jersey plans with prescription coverage now have access to an improved, mobile-friendly&nbsp;online experience at <a href="http://www.Alliancerxwp.com/">Alliancerxwp.com</a>. This website replaces <a href="https://www.walgreens.com/topic/s/mail_service_pharmacy_primemail.jsp">Walgreens.com/PrimeMail</a>.</p> <p>Members can access their pharmacy information, including the new home delivery site, by signing in at <a href="http://horizonblue.com/">HorizonBlue.com</a>, then:</p> <ul> <li>Selecting <i>Doctors &amp; Care</i></li> <li>Clicking <i>Pharmacy</i>, and then Go to Your <i>Prime Therapeutics</i></li> </ul> <p>Once signed in, members can review their prescription history, and cost and coverage information and more.</p> <p>The new site is also available at <a href="http://www.Alliancerxwp.com/">Alliancerxwp.com</a>. Members registered on the former website, <a href="https://www.walgreens.com/topic/s/mail_service_pharmacy_primemail.jsp">Walgreens.com/PrimeMail</a>, will retain the same user names and passwords when using <a href="http://www.Alliancerxwp.com/">Alliancerxwp.com</a>.</p> <p>Horizon BCBSNJ members who have questions about home delivery or the new website can call AllianceRx Walgreens Prime, 24 hours per day, seven days a week, at <span class="class-bold">1-888-844-3828</span>. Medicare and Medicare Advantage members may call&nbsp;<span class="class-bold">1-800-391-1906</span>, also available 24 hours per day, seven days per week.</p> <p><small>PrimeMail by Walgreens Mail Service recently changed its name to AllianceRx Walgreens Prime. Horizon BCBSNJ’s pharmacy benefit manager, Prime Therapeutics LLC (Prime), formed a joint venture with Walgreens Mail Service for home delivery of prescription medicines. </small></p> <p><small>Prime Therapeutics LLC is an independent company that provides a pharmacy benefit management services for Horizon Blue Cross Blue Shield of New Jersey. Prime Therapeutics has an ownership interest in AllianceRx Walgreens Prime, a central specialty and home delivery pharmacy. Prime Therapeutics and AllianceRx Walgreens are independent from and not affiliated with Horizon Blue Cross Blue Shield of New Jersey.</small></p> </div> Mon, 30 Jul 2018 07:40:15 +0000 horizonbcbsnj 3975 at https://www.horizonblue.com Announcing an Improved Home Delivery Website for Horizon BCBSNJ Pharmacy Members https://www.horizonblue.com/brokers/news/broker-news/announcing-an-improved-home-delivery-website-for-horizon-bcbsnj-pharmacy-members <span class="field field--name-title field--type-string field--label-hidden">Announcing an Improved Home Delivery Website for Horizon BCBSNJ Pharmacy Members </span> <span class="field field--name-created field--type-created field--label-hidden">Mon, 07/30/2018 - 03:25</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">July 25, 2018</span></p> <p><span class="class-bold">Applies to:</span> All commercial markets</p> <p>Members enrolled in Horizon Blue Cross Blue Shield of New Jersey plans with prescription coverage now have access to an improved, mobile-friendly&nbsp;online experience when managing home delivery of their prescriptions through AllianceRx Walgreens Prime.</p> <p>Members can access their pharmacy information, including the new home delivery site, by signing in at <a href="http://horizonblue.com/">HorizonBlue.com</a>, then:</p> <ul> <li>Selecting <em>Doctors &amp; Care</em></li> <li>Clicking <em>Pharmacy</em>, and then <em>Go to Your Prime Therapeutics</em></li> </ul> <p>Once signed in, members can review their prescription history, and cost and coverage information and more.</p> <p>The new site is also available at <a href="http://www.Alliancerxwp.com/">Alliancerxwp.com</a>. Members registered on the former website, <a href="https://www.walgreens.com/topic/s/mail_service_pharmacy_primemail.jsp">Walgreens.com/PrimeMail</a>, will retain the same user names and passwords when using <a href="http://www.Alliancerxwp.com/">Alliancerxwp.com</a>.</p> <p>Horizon BCBSNJ members who have questions about home delivery or the new website can call AllianceRx Walgreens Prime, 24 hours per day, seven days per week, at <span class="class-bold">1-888-844-3828</span>. Medicare and Medicare Advantage members may call<span class="class-bold"> 1-800-391-1906</span>, also available 24 hours per day, seven days per week.</p> <p>If you have questions, please contact your Horizon BCBSNJ sales executive or account manager.</p> <p><small>PrimeMail by Walgreens Mail Service recently changed its name to AllianceRx Walgreens Prime. Horizon BCBSNJ’s pharmacy benefit manager, Prime Therapeutics LLC (Prime), formed a joint venture with Walgreens Mail Service for home delivery of prescription medicines. </small></p> <p><small>Prime Therapeutics LLC is an independent company that provides a pharmacy benefit management services for Horizon Blue Cross Blue Shield of New Jersey. Prime Therapeutics has an ownership interest in AllianceRx Walgreens Prime, a central specialty and home delivery pharmacy. Prime Therapeutics and AllianceRx Walgreens are independent from and not affiliated with Horizon Blue Cross Blue Shield of New Jersey. </small></p> </div> Mon, 30 Jul 2018 07:25:01 +0000 horizonbcbsnj 3972 at https://www.horizonblue.com Medical Policy Revision: Autografts and Allografts in the Treatment of Focal Articular Cartilage Lesions https://www.horizonblue.com/providers/news/news-legal-notices/medical-policy-revision-autografts-and-allografts-treatment-of-focal-articular-cartilage-lesions <span class="field field--name-title field--type-string field--label-hidden">Medical Policy Revision: Autografts and Allografts in the Treatment of Focal Articular Cartilage Lesions</span> <span class="field field--name-created field--type-created field--label-hidden">Fri, 07/27/2018 - 13:41</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>Effective <strong>November 1, 2018</strong>, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain professional claims for the treatment of focal articular cartilage lesions.</p> <p>We encourage you to visit our <a href="https://services3.horizon-bcbsnj.com/hcm/MedPol2.nsf">Medical Policy Manual</a> to review the guidelines of our medical policy, <em>Autografts and Allografts in the Treatment of Focal Articular Cartilage Lesions</em>, which identify when certain procedures are considered medically necessary.</p> <hr /> <p>Based on the guidelines of our revised medical policy, <em>Autografts and Allografts in the Treatment of Focal Articular Cartilage Lesions, </em>claims for services provided on and after November 1, 2018 will be processed as noted below.</p> <ul> <li>Claims for services provided to patients who are between 15 and 55 years of age that include CPT® codes <strong>27415</strong>, <strong>27416</strong>, <strong>29866</strong> and/or <strong>29867 </strong>will pend, regardless of the submitted diagnosis code(s), while information required to determine medical appropriateness is requested and reviewed. <p>If we determine, following our review, that the services in question do not meet the criteria of our policy, CPT codes <strong>27415</strong>, <strong>27416</strong>, <strong>29866</strong> and/or <strong>29867 </strong>will be denied as experimental/investigational services.</p> </li> </ul> <p>Unless Horizon BCBSNJ gives written notice that all or part of the above changes have been cancelled or postponed, the changes will be applied to claims for dates of service on and after November 1, 2018.</p> <p>CPT® is a registered mark of the American Medical Association.</p> </div> Fri, 27 Jul 2018 17:41:01 +0000 horizonbcbsnj 3971 at https://www.horizonblue.com Medical Policy Update - Artificial Intervertebral Disc: Lumbar Spine https://www.horizonblue.com/providers/news/news-legal-notices/medical-policy-update-artificial-intervertebral-disc-lumbar-spine <span class="field field--name-title field--type-string field--label-hidden">Medical Policy Update - Artificial Intervertebral Disc: Lumbar Spine</span> <span class="field field--name-created field--type-created field--label-hidden">Fri, 07/27/2018 - 13:26</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>Effective <strong>August 27, 2018</strong>, claims for certain services provided to patients enrolled in Horizon Blue Cross Blue Shield of New Jersey Medicare Advantage (MA) plans will also be processed according to our medical policy, <em>Artificial Intervertebral Disc: Lumbar Spine</em>.</p> <p>Our medical policy, <em>Artificial Intervertebral Disc: Lumbar Spine</em><em>,</em> has been updated to include reference to the National Coverage Determination (NCD) and the Local Coverage Determination (LCD) noted below. Horizon BCBSNJ will follow these NCDs/LCDs and Centers for Medicare &amp; Medicaid Services (CMS) guidance in our processing of claims for services provided to Horizon BCBSNJ MA members.</p> <ul> <li>NCD 150.10: <em>Lumbar Artificial Disc Replacement (LADR)</em></li> <li>LCD L35094: <em>Services That Are Not Reasonable and Necessary</em></li> </ul> <p>We encourage you to access our <a href="https://services3.horizon-bcbsnj.com/hcm/MedPol2.nsf" target="_blank">Medical Policy Manual</a> to review our medical policy, <em>Artificial Intervertebral Disc: Lumbar Spine</em><em>.</em></p> <hr /> <p>Claims submitted for services provided on and after August 27, 2018 to members enrolled in Horizon BCBSNJ MA plans will be processed as noted below.</p> <ul> <li>CPT® codes <strong>22857</strong>, <strong>22865</strong>, <strong>22862</strong>, <strong>+0163T</strong>, <strong>+0164T</strong> and/or <strong>+0165T</strong> will be denied as an experimental/investigational services regardless of the submitted diagnosis code(s).</li> </ul> <p>Unless Horizon BCBSNJ gives written notice that all or part of the above changes have been cancelled or postponed, the changes will be applied to claims on and after August 27, 2018.</p> <p>CPT® is a registered mark of the American Medical Association.</p> </div> Fri, 27 Jul 2018 17:26:29 +0000 horizonbcbsnj 3970 at https://www.horizonblue.com PA/MND Process https://www.horizonblue.com/providers/products-programs/turningpoint-healthcare-solutions/pa-mnd-process <span class="field field--name-title field--type-string field--label-hidden">PA/MND Process</span> <span class="field field--name-created field--type-created field--label-hidden">Wed, 07/25/2018 - 04:50</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>Through the Surgical and Implantable Device Management Program, TurningPoint will conduct PA/MND review for orthopedic services and related devices to:</p> <ul> <li>Determine medical necessity</li> <li>Ensure appropriate conservative therapies are attempted prior to invasive procedures</li> <li>Ensure the most appropriate surgery is performed</li> <li>Ensure the right device is selected for the right patient</li> <li>Ensure the procedure is performed in the right setting</li> <li>Improve health care professional best practices</li> </ul> <p>On <b>October 22, 2018</b>, TurningPoint will begin accepting PA/MND requests <a href="/sites/default/files/2018-07/Code List.pdf">for services to be performed </a>on or after <b>November 1, 2018</b>.</p> <p><b>PHYSICIAN RESPONSIBILITIES</b></p> <p>Physicians (both participating and nonparticipating) are required to obtain PA/MND from TurningPoint prior to performing services included as part of this program to be provided to Horizon BCBSNJ members enrolled in fully insured products (and to those Horizon BCBSNJ members enrolled in fully insured products that include BlueCard® benefits when services are to be provided within another Blue Cross and Blue Shield plan’s service area).</p> <p>PA/MND requests may be submitted to TurningPoint:</p> <ul> <li>Beginning <b>October 22, 2018</b>, you may log on to NaviNet® to submit a request.<br /> &nbsp;</li> <li>If you do not have access to NaviNet, you can submit a request using TurningPoint’s web portal at <a href="https://www.myturningpoint-healthcare.com">https://www.myturningpoint-healthcare.com</a>. To register for access to TurningPoint’s web portal, call TurningPoint at <b>1-833-436-4083</b>, Monday through Friday between 8 a.m. and 5 p.m., ET. You may also call TurningPoint at this phone number to submit PA/MND requests.</li> </ul> <p>When contacting TurningPoint to obtain a PA/MND, please have the following information available:</p> <ul> <li>The member’s name, date of birth and Horizon BCBSNJ ID number<br /> &nbsp;</li> <li>The rendering, referring or ordering physician’s name, NPI/TIN, contact information (including fax number). Please also include the name and information of any co-surgeon or assistant surgeon, if any are anticipated to be necessary.<br /> &nbsp;</li> <li>The rendering facility’s name, NPI/TIN, location address, contact information (including fax number)<br /> &nbsp;</li> <li>CPT® codes and diagnosis codes<br /> &nbsp;</li> <li>Place of service<br /> &nbsp;</li> <li>All relevant clinical notes, imaging/X-ray reports and any anticipated implant, technology or hardware to be used<br /> &nbsp;</li> <li>Out-of-Network Health Care Professionals to be used: At the time a PA/MND request is made, the referring/rendering physician is responsible to provide TurningPoint with information about the planned use of an out-of-network provider (co-surgeon, assistant surgeon, anesthesiologist, facility, etc.) in the surgical procedure.</li> </ul> <p>TurningPoint will use this information to make determinations for PA/MND requests and to perform claim reviews.</p> <p><b>FACILITY RESPONSIBILITIES</b></p> <p>Rendering hospitals and ambulatory surgical centers are encouraged to confirm with the rendering physician or TurningPoint that an approved authorization or pre-service MND has been obtained.</p> <p>Rendering facilities may confirm the status of a PA/MND by one of the following methods:</p> <ul> <li>Beginning <b>October 22, 2018</b>, you may log on to NaviNet&nbsp;to confirm the status of a PA/MND request.<br /> &nbsp;</li> <li>If you do not have access to NaviNet, you can confirm the status of a PA/MND request at <a href="https://www.myturningpoint-healthcare.com">https://www.myturningpoint-healthcare.com</a>. To register for access to TurningPoint’s web portal, please call TurningPoint at <b>1-833-436-4083</b>, Monday through Friday between 8 a.m. and 5 p.m., ET.<br /> &nbsp;</li> <li>You may also call TurningPoint at <b>1-833-436-4083</b> to confirm the status of a PA/MND.</li> </ul> <p>&nbsp;</p> <p><em>CPT</em><em>®</em><em> is a registered trademark of the American Medical Association. </em></p> <p><em>NaviNet</em><em>®</em><em> is a registered trademark of NaviNet, Inc.</em></p> <p><em>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.</em></p> </div> Wed, 25 Jul 2018 08:50:50 +0000 horizonbcbsnj 3969 at https://www.horizonblue.com Medical Policy Criteria and Guidelines https://www.horizonblue.com/providers/products-programs/turningpoint-healthcare-solutions/medical-policy-criteria-and-guidelines <span class="field field--name-title field--type-string field--label-hidden">Medical Policy Criteria and Guidelines</span> <span class="field field--name-created field--type-created field--label-hidden">Wed, 07/25/2018 - 04:50</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>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 <b>November 1, 2018</b> and will only apply to those Horizon BCBSNJ fully insured members included within the scope of this program.</p> <ul> <li>You may obtain copies of the medical policy criteria and guidelines by calling TurningPoint at <b>1-833-436-4083</b>, Monday through Friday between 8 a.m. and 5 p.m., Eastern Time (ET).<br /> &nbsp;</li> <li>Beginning <b>October 22, 2018</b>, access to the medical policy criteria and guidelines will be available via NaviNet®.</li> </ul> <p style="margin-left:35px;">Practices that do not have access to NaviNet may request access to TurningPoint’s web portal by calling TurningPoint at <b>1-833-436-4083</b>, Monday through Friday between 8 a.m. and 5 p.m., ET to register to obtain access credentials.</p> <p>&nbsp;</p> <p><em>CPT</em><em>®</em><em> is a registered trademark of the American Medical Association. </em></p> <p><em>NaviNet</em><em>®</em><em> is a registered trademark of NaviNet, Inc.</em></p> <p><em>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.</em></p> </div> Wed, 25 Jul 2018 08:50:48 +0000 horizonbcbsnj 3968 at https://www.horizonblue.com About the Surgical and Implantable Device Management Program https://www.horizonblue.com/providers/products-programs/turningpoint-healthcare-solutions/about-surgical-and-implantable-device-management-program <span class="field field--name-title field--type-string field--label-hidden">About the Surgical and Implantable Device Management Program</span> <span class="field field--name-created field--type-created field--label-hidden">Wed, 07/25/2018 - 04:50</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>Beginning <b>November 1, 2018</b>, Horizon Blue Cross Blue Shield of New Jersey will collaborate with TurningPoint Healthcare Solutions, LLC (TurningPoint) to administer our <b>Surgical and Implantable Device Management Program</b>.</p> <p>As part of this program, TurningPoint will conduct Prior Authorization &amp; Medical Necessity Determination (PA/MND) reviews of <a href="/sites/default/files/2018-07/Code List.pdf">certain orthopedic surgical services </a>(many of which include implantable devices), and other related services, for members enrolled in Horizon BCBSNJ fully insured plans/products and that are requested by participating and nonparticipating physicians rendered in the following settings:</p> <ul> <li>Inpatient</li> <li>Outpatient</li> <li>Ambulatory Surgical Center</li> <li>Physician’s Office</li> </ul> <p>Services rendered in the observation setting or the Emergency Room (ER) do not require PA/MND.</p> <p>TurningPoint will also perform PA/MND of services to be provided to those Horizon BCBSNJ members enrolled in fully insured plans/products that include BlueCard® benefits when services are to be provided outside of Horizon BCBSNJ’s local service area. (Horizon BCBSNJ’s local service area includes&nbsp;the State of New Jersey, contiguous counties in DE, NY and PA as well as Lehigh County, PA.)</p> <p>Obtaining an approved PA/MND from TurningPoint will ensure that the services in question will be considered medically necessary.</p> <p><b>TurningPoint will accept requests for PA/MNDs starting on October 22, 2018 for any <a href="/sites/default/files/2018-07/Code List.pdf">in-scope orthopedic surgical procedures</a> to be performed on or after November 1, 2018</b>.</p> <p>Physicians are strongly encouraged to obtain a pre-service MND from TurningPoint for services to be provided to patients whose benefits do not require PA of services rendered in an outpatient setting or in a physician’s office.</p> <p>As part of our <b>Surgical and Implantable Device Management Program</b>, TurningPoint will review professional and facility claims submitted for services rendered on or after <b>November 1, 2018</b>. Services that TurningPoint deems not medically necessary as part of this review may not be eligible for coverage or payment by Horizon BCBSNJ. Horizon BCBSNJ reserves the right to adjust claims based on TurningPoint’s recommendations.</p> <p><a href="/sites/default/files/2018-07/Code List.pdf">Review the full listing of procedures subject to PA/MND as part of our Surgical and Implantable Device Management Program</a>.<br /> &nbsp;</p> <p><strong>Resources</strong></p> <p><a href="/sites/default/files/2018-07/Q_A.pdf">Surgical and Implantable Device Management Program Q &amp; A</a></p> <p><a href="/providers/news/news-legal-notices">Horizon BCBSNJ announcement of the Surgical and Implantable Device Management Program</a></p> <p>&nbsp;</p> <p><em>CPT</em><em>®</em><em> is a registered trademark of the American Medical Association. </em></p> <p><em>NaviNet</em><em>®</em><em> is a registered trademark of NaviNet, Inc.</em></p> <p><em>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.</em></p> </div> Wed, 25 Jul 2018 08:50:46 +0000 horizonbcbsnj 3967 at https://www.horizonblue.com TurningPoint Healthcare Solutions https://www.horizonblue.com/providers/products-programs/turningpoint-healthcare-solutions <span class="field field--name-title field--type-string field--label-hidden">TurningPoint Healthcare Solutions</span> <span class="field field--name-created field--type-created field--label-hidden">Wed, 07/25/2018 - 04:48</span> Wed, 25 Jul 2018 08:48:10 +0000 horizonbcbsnj 3966 at https://www.horizonblue.com Member ID Cards and Proof of Coverage Options Available Online https://www.horizonblue.com/brokers/news/broker-news/member-id-cards-and-proof-of-coverage-options-available-online <span class="field field--name-title field--type-string field--label-hidden">Member ID Cards and Proof of Coverage Options Available Online</span> <span class="field field--name-created field--type-created field--label-hidden">Tue, 07/24/2018 - 03:19</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p><strong>July 17, 2018</strong></p> <p><strong>Applies to:</strong> All Markets</p> <p>Horizon Blue Cross Blue Shield of New Jersey members who have not yet received or have misplaced their member ID card have options available to them from the convenience of their computer, phone or other web-enabled device.</p> <p>Members can display and/or print a copy of their member ID card – as well as order a permanent replacement – by registering and signing in at HorizonBlue.com/register. Once signed in, the member simply clicks <em>ID Cards</em> and follows the instructions.</p> <p>Share the attached flyer with your group and individual clients to let them know about the convenient options available to them.</p> <p>If you have questions, please contact your Horizon BCBSNJ sales executive or account manager.</p> <p><a href="/sites/default/files/Proof_Of_Coverage.pdf">View PDF Version</a></p> </div> Tue, 24 Jul 2018 07:19:59 +0000 horizonbcbsnj 3965 at https://www.horizonblue.com FDA Recalls Valsartan https://www.horizonblue.com/providers/news/news-legal-notices/fda-recalls-valsartan <span class="field field--name-title field--type-string field--label-hidden">FDA Recalls Valsartan</span> <span class="field field--name-created field--type-created field--label-hidden">Fri, 07/20/2018 - 14:07</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>The U.S. Food and Drug Administration (FDA) is alerting health care professionals and their patients of a voluntary recall of several drug products containing the active ingredient valsartan, used to treat high blood pressure and heart failure. This recall is due to an impurity, N-nitrosodimethylamine (NDMA), which was found in the recalled products. However,&nbsp;<strong>not all products containing valsartan are being recalled</strong>.</p> <p>Only those valsartan-containing medicines which have the valsartan active pharmaceutical ingredient (API) supplied by a specific third-party company are affected. The supplier has stopped distributing its valsartan API and the FDA is working with the affected manufacturers to reduce or eliminate the valsartan API impurity from future products.</p> <p>The manufacturers listed below are recalling all non-expired products that contain valsartan:</p> <ul> <li>valsartan, Major Pharmaceuticals</li> <li>valsartan, Solco Healthcare</li> <li>valsartan, Teva Pharmaceuticals Industries Ltd or Actavis</li> <li>valsartan/Hydrochlorothiazide (HCTZ), Solco Healthcare</li> <li>valsartan/Hydrochlorothiazide (HCTZ), Teva Pharmaceuticals Industries Ltd</li> </ul> <p>For more information, please visit the <a href="https://www.fda.gov/safety/recalls/ucm613625.htm">FDA website</a>.</p> </div> Fri, 20 Jul 2018 18:07:00 +0000 horizonbcbsnj 3964 at https://www.horizonblue.com Horizon BCBSNJ Honored With 2018 Digital Edge 50 Award For Excelling at Digital Transformation https://www.horizonblue.com/employers/news/employer-news/horizon-bcbsnj-honored-2018-digital-edge-50-award-for-excelling-at-digital-transformation <span class="field field--name-title field--type-string field--label-hidden">Horizon BCBSNJ Honored With 2018 Digital Edge 50 Award For Excelling at Digital Transformation</span> <span class="field field--name-created field--type-created field--label-hidden">Thu, 07/19/2018 - 02:57</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p><b>July 11, 2018</b></p> <p>Horizon Blue Cross Blue Shield of New Jersey received a 2018 Digital Edge 50 Award from IDG Enterprise, a leading technology media, data and technology services company for its Domain Security Platform. This prestigious recognition honors a select group of 50 organizations for digital initiatives that are transforming the way they operate, how they interact with customers and the products they have in market. Complexity, scale, impact and innovation are all part of what makes an initiative worthy of a Digital Edge 50 award.</p> <p>Horizon BCBSNJ created the Domain Security Platform to automatically identify, monitor and block potentially malicious, newly-registered external domains and websites that have not yet been detected by existing security products and are likely to pose an elevated risk to the Company and our members. The Domain Security Platform provides the Company an enhanced ability to protect our member data.</p> <p>Horizon BCBSNJ has an obligation and commitment to protect the security and confidentiality of our members’ data. As a result, the Company believes that security is a foundational element of any digital platform or initiative, and is critical to the successful operation of our business.</p> <p>Horizon BCBSNJ joins an elite and well-deserving group of peers with this 2018 Digital Edge 50 Award. Only those organizations with significant projects and impressive business results made the list.</p> </div> Thu, 19 Jul 2018 06:57:07 +0000 horizonbcbsnj 3963 at https://www.horizonblue.com Terms and Conditions for SMS Opt-Out https://www.horizonblue.com/tcs-79275 <span class="field field--name-title field--type-string field--label-hidden">Terms and Conditions for SMS Opt-Out</span> <span class="field field--name-created field--type-created field--label-hidden">Wed, 07/18/2018 - 09:32</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p><strong>Program Description</strong></p> <p>Shortcode : 79275</p> <p>Campaign Name: Horizon BCBSNJ</p> <p>Program Description: Enterprise business-related alerts to employees and customers</p> <p>Frequency: Message frequency depends on account preference</p> <p>Pricing: Horizon BCBSNJ does not charge for this service, although message and data rates apply</p> <p>Primary Contact: Horizon BCBSNJ, <strong>1-877-276-7266</strong>, <a href="mailto:support-us@2sms.com">support-us@2sms.com</a></p> <p>Application Provider: 2sms, LLC</p> <p>2sms Contact: (p) <strong>1-877-276-7266</strong>, (e) <a href="mailto:support-us@2sms.com">support-us@2sms.com</a>, (w) <a href="http://www.2sms.com/35842/www.2sms.com">www.2sms.com</a></p> <p><strong>Terms and Conditions</strong></p> <p>NEITHER HORIZON BCBSNJ NOR ITS EMPLOYEES, AGENTS, SUCCESSORS, AND/OR ASSIGNS MAKE ANY WARRANTIES, EXPRESS OR IMPLIED, INCLUDING THE WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE, OR ASSUME ANY LEGAL LIABILITY OR RESPONSIBILITY FOR THE ACCURACY, ADEQUACY, QUALITY, COMPLETENESS, OR TIMELINESS OF ANY INFORMATION CONTAINED AT THIS WEBSITE. FURTHER, HORIZON BCBSNJ SHALL NOT BE LIABLE FOR ANY DIRECT, INDIRECT, SPECIAL, CONSEQUENTIAL, OR INCONSEQUENTIAL DAMAGES TO THE USER, OR A THIRD PARTY ARISING FROM THE USE OR RELIANCE UPON THE INFORMATION CONTAINED ON THE WEBSITE, OR ANY OTHER LINKED WEBSITE, INCLUDING WITHOUT LIMITATION, ANY LOST PROFITS, BUSINESS INTERRUPTION, OR LOST DATA, EVEN IF HORIZON BCBSNJ HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES, AND REGARDLESS OF THE FORM OF THE ACTION.</p> <p><strong>Privacy</strong></p> <p>Neither Horizon Blue Cross Blue Shield of New Jersey nor 2sms LLC will share or use your mobile number for any other purpose.</p> <p><strong>Fees</strong></p> <p>Neither Horizon Blue Cross Blue Shield of New Jersey nor 2sms charges users fees to receive text messages from 79275. However, standard message and data rates may apply.</p> <p><strong>Opt-In</strong></p> <p>You may opt-in to Horizon BCBSNJ’s two-factor authentication program by contacting 2sms via email at <a href="mailto:support-us@2sms.com">support-us@2sms.com</a> or via phone at <strong>1-877-276-7266</strong>. By opting in to this program,&nbsp;you agree to receive text messages from 2sms based on the account preferences.</p> <p><strong>Opt-Out</strong></p> <p>To opt-out of the Horizon BCBSNJ two-factor authentication program, reply <strong>STOP</strong>, <strong>QUIT</strong>, <strong>END</strong>, <strong>CANCEL</strong>, <strong>UNSUBSCRIBE</strong> or <strong>REMOVE</strong> to 79275 from your mobile device. You will not receive any additional messages from short code 79275 unless you opt-in again.</p> <p><strong>Help</strong></p> <p>To get help, text <strong>HELP</strong> to 35842 or email <a href="mailto:support-us@2sms.com">support-us@2sms.com</a> or call us at <strong>1-877-276-7266</strong>.</p> <p><strong>Wireless Operator Reachlist</strong></p> <p>Alltel®, Associated Carrier Group (ACG), AT&amp;T®, Boost Mobile®, Cincinnati Bell®, Cricket®, Google Voice, MetroPCS®, Nextel®, Rural Carrier Group, Sprint®, Tier 2/3 Carrier Group, T-Mobile®, U.S. Cellular®, Verizon Wireless®, Virgin Mobile USA</p> <p><strong>Warranty</strong></p> <p>Horizon Blue Cross Blue Shield of New Jersey nor 2sms LLC will be liable for any delays in the receipt of any SMS messages connected with this program. Delivery of SMS messages is subject to effective transmission from your wireless service provider/network operator to your mobile device.</p> <p><strong>Privacy Policy</strong></p> <p>Horizon Blue Cross Blue Shield of New Jersey and 2sms LLC respects your privacy. We will only use information you provide to transmit your text message. Nonetheless, we reserve the right at all times to disclose any information as necessary to satisfy any legal, regulatory or governmental request, to avoid liability, or to protect our rights or property. When you complete forms online or otherwise provide an organization the information in connection with the service, you agree to provide accurate, complete, and true information. You agree not to use a false or misleading name or a name that you are not authorized to use. If we, in our sole discretion, believe that any such information is untrue, inaccurate, or incomplete, we may refuse you access to the service and pursue any appropriate legal remedies. View Horizon BCBSNJ’s <a href="/privacy-policy">complete privacy policy</a>.</p> </div> Wed, 18 Jul 2018 13:32:07 +0000 horizonbcbsnj 3962 at https://www.horizonblue.com Horizon BCBSNJ Honored With 2018 Digital Edge 50 Award For Excelling at Digital Transformation https://www.horizonblue.com/brokers/news/broker-news/horizon-bcbsnj-honored-2018-digital-edge-50-award-for-excelling-at-digital-transformation <span class="field field--name-title field--type-string field--label-hidden">Horizon BCBSNJ Honored With 2018 Digital Edge 50 Award For Excelling at Digital Transformation</span> <span class="field field--name-created field--type-created field--label-hidden">Tue, 07/17/2018 - 02:52</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p><strong>July 11, 2018</strong></p> <p><strong>Applies to:</strong> All Markets</p> <p>Horizon Blue Cross Blue Shield of New Jersey received a 2018 Digital Edge 50 Award from IDG Enterprise, a leading technology media, data and technology services company for its Domain Security Platform. This prestigious recognition honors a select group of 50 organizations for digital initiatives that are transforming the way they operate, how they interact with customers and the products they have in market. Complexity, scale, impact and innovation are all part of what makes an initiative worthy of a Digital Edge 50 award.</p> <p>Horizon BCBSNJ created the Domain Security Platform to automatically identify, monitor and block potentially malicious, newly-registered external domains and websites that have not yet been detected by existing security products and are likely to pose an elevated risk to the Company and our members. The Domain Security Platform provides the Company an enhanced ability to protect our member data.</p> <p>Horizon BCBSNJ has an obligation and commitment to protect the security and confidentiality of our members’ data. As a result, the Company believes that security is a foundational element of any digital platform or initiative, and is critical to the successful operation of our business.</p> <p>Horizon BCBSNJ joins an elite and well-deserving group of peers with this 2018 Digital Edge 50 Award. Only those organizations with significant projects and impressive business results made the list.</p> <p>If you have questions, please contact your Horizon BCBSNJ sales executive or account manager.</p> </div> Tue, 17 Jul 2018 06:52:14 +0000 horizonbcbsnj 3961 at https://www.horizonblue.com Study: Horizon BCBSNJ’s Work to Combat Opioid Abuse Makes It a National Leader https://www.horizonblue.com/brokers/news/broker-news/study-horizon-bcbsnj-s-work-to-combat-opioid-abuse-makes-it-a-national-leader <span class="field field--name-title field--type-string field--label-hidden">Study: Horizon BCBSNJ’s Work to Combat Opioid Abuse Makes It a National Leader</span> <span class="field field--name-created field--type-created field--label-hidden">Tue, 07/17/2018 - 02:22</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>Horizon Blue Cross Blue Shield of New Jersey recently released a <a href="https://horizonviewpoints.com/study-horizons-work-to-combat-opioid-abuse-make-it-a-national-leader">report</a> demonstrating that the Company is a national leader when it comes to preventing, combating and treating opioid abuse. The Company reported that the programs it developed over the past several years collaborating with prescribers, pharmacies and patients spurred a dramatic reduction in the number of opioid prescriptions dispensed between 2013 and 2017 and the highest rate of compliance with CDC-recommended dose and duration guidelines among all Blue Cross and/or Blue Shield Plans nationally. The Company also reported a 350 percent increase in spending to treat opioid use disorder (OUD) during that time period, underscoring its commitment to helping members get the care they need.</p> <p>The announcement comes on the heels of a <a href="http://www.njspotlight.com/stories/18/06/21/interactive-map-where-opioids-are-exacting-the-highest-death-toll-in-new-jersey/">report</a> citing data from the New Jersey Attorney General’s Office indicating that the state is on a pace to reach or exceed 3,000 opioid-related deaths by the end of the year, which would represent an increase of one-third over 2016.</p> <p>Earlier this year, the Company announced that over the next five years it would invest $125 million it expects in refunds resulting from federal tax reform in significant initiatives that will drive improvements in health care in several areas, including behavioral health, substance abuse prevention and addiction and recovery. The Company launched its first program to stem prescription drug abuse in 1999.</p> <p>“While the results are encouraging, we are faced with daily reminders that fully understanding and combating this public health crisis requires greater collaboration and engagement at virtually every level and Horizon is committed to that goal,” said Kevin P. Conlin, Chairman, CEO and President of Horizon BCBSNJ. “Horizon is devoting a substantial part of the federal tax refund it is getting to increase prevention and treatment, expand community outreach and intensify our multi-faceted, long-term strategy to help our members stay or become addiction-free. We are determined to continue to be a national leader when it comes to winning the fight against opioids.”</p> <p>The report, examining four years of medical and prescription claim data, also found:</p> <ul> <li><em>Horizon BCBSNJ commercially insured members filling at least one opioid prescription annually dropped by 28 percent, bettering the 25 percent reduction <a href="https://www.bcbs.com/the-health-of-america/reports/the-opioid-epidemic-america-update?utm_source=bcbscom&utm_medium=page&utm_content=&utm_campaign=HoA-opioidleadership">reported</a> nationally by all Blue Cross and/or Blue Shield Plans over the same period.</em></li> <li><em>Sixty-two percent of Horizon BCBSNJ commercially insured members’ cumulative opioid use in 2017 was within the CDC-recommended dose and duration guidelines up from up from 55 percent in 2013 – the highest nationally among all Blue Cross and/or Blue Shield Plans.</em></li> <li><em>In 2016, OUD among commercially insured members peaked with slightly more than seven in 1,000 members diagnosed. This diagnosis rate remained stable in 2017.</em></li> </ul> <p>“It takes a comprehensive, integrated strategy to tackle an epidemic as complex as opioid addiction,” said Allen Karp, Executive Vice President for Healthcare Management and Transformation for Horizon BCBSNJ. “That’s why Horizon’s response to the opioid crisis is far-reaching and encompasses three key areas: Education and Prevention, Treatment and Recovery, and Community Outreach. We are increasing our investment and building strategic, collaborative partnerships in every area to help our members.”</p> <p>Increased treatment and recovery are a major component of Horizon BCBSNJ’s multi-faceted efforts. The Company has:</p> <ul> <li>Piloted programs funding recovery and peer support specialists in hospital Emergency Rooms to connect patients with substance abuse problems to treatment;</li> <li>Developed an innovative episode of care program for Substance Use Disorders (SUDs); and</li> <li>Expanded access to behavioral health and SUD providers.</li> </ul> <p>Furthering its longstanding commitment to combat New Jersey’s opioid crisis, in November 2017 Horizon BCBSNJ signed on to Shatterproof’s national coalition of 16 health insurance companies agreeing to adopt eight “National Principles of Care” for the treatment of addiction that will improve outcomes and save lives.</p> <p>“By leveraging best-practice education and preventive interventions that target at-risk members and prescribers, Horizon has been able to identify, intervene and prevent the abuse of opioids. We use advanced analytics to better understand what is happening and to stop or prevent abuse,” said Dr. Tom Graf, Chief Medical Officer for Horizon BCBSNJ. These programs include:</p> <ul> <li><strong>The Opioid Alert Program</strong>, in which members who meet high thresholds of morphine equivalent dose of opioids are identified and are referred to Horizon BCBSNJ’s behavioral health or case management program for intervention when appropriate.</li> <li><strong>Pharmacy Lock-in Program</strong>, in which members are identified as high-risk for abuse based on the number of duplicate fills for opioid prescriptions at multiple pharmacies, and limits those identified to filling their prescriptions at a single pharmacy. In 2016 alone, Horizon BCBSNJ reached out to 12,000 Medicaid members through this program to reduce opioid use prescriptions by 37 percent.</li> <li><strong>Prescriber Initiatives</strong>. The program focuses on educating prescribers on how to reduce high-risk behaviors, reduce morphine equivalent dose, access a prescription monitoring program database and identify high-risk member behaviors.</li> </ul> <p>Horizon BCBSNJ has also launched a significant public outreach and engagement program aimed at bolstering educational efforts. This has involved:</p> <ul> <li>The development with Rutgers University of an opioids toolkit that has been used to help community-based organizations raise opioids awareness including among more than 3,000 middle school- and high school-age children in New Jersey;</li> <li>The award-winning Knock Out Opioid Abuse Town Hall series developed with the Partnership for A Drug Free New Jersey. Beginning in April 2017, the 21 town halls brought together more than 13,000 New Jersey residents in every county and provided them with a comprehensive understanding of the causes and effects of the opioid epidemic. The events included participation from county prosecutors, state legislators, and doctors and professionals from the prevention, treatment and recovery fields.</li> <li>The establishment of a co-branded partnership with Walgreens for Safe Med Disposal kiosks to increase opportunities to safely remove unused opioids from the community.</li> </ul> <p>If you have questions, please contact your Horizon BCBSNJ sales executive or account manager.</p> </div> Tue, 17 Jul 2018 06:22:28 +0000 horizonbcbsnj 3960 at https://www.horizonblue.com Study: Horizon's Work to Combat Opioid Abuse Makes it a National Leader https://www.horizonblue.com/about-us/news/newsroom/study-horizon-s-work-to-combat-opioid-abuse-makes-it-a-national-leader <span class="field field--name-title field--type-string field--label-hidden">Study: Horizon's Work to Combat Opioid Abuse Makes it a National Leader</span> <span class="field field--name-created field--type-created field--label-hidden">Thu, 07/12/2018 - 16:00</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) released a <a href="https://horizonviewpoints.com/study-horizons-work-to-combat-opioid-abuse-make-it-a-national-leader">report</a> today demonstrating that the company is a national leader when it comes to preventing, combating and treating opioid abuse. The company reported that the programs it developed over the past several years collaborating with prescribers, pharmacies and patients spurred a dramatic reduction in the number of opioid prescriptions dispensed between 2013 and 2017 and the highest rate of compliance with CDC-recommended dose and duration guidelines among all Blue Cross Blue Shield plans nationally. The company also reported a 350% increase in spending to treat opioid use disorder during that time period underscoring its commitment to helping members get the care they need.</p> <p>The announcement comes on the heels of a <a href="http://www.njspotlight.com/stories/18/06/21/interactive-map-where-opioids-are-exacting-the-highest-death-toll-in-new-jersey/">report</a> citing data from the NJ Attorney General’s Office indicating that the state is on a pace to reach or exceed 3,000 opioid-related deaths by the end of the year, which would represent an increase of one-third over 2016.</p> <p>Earlier this year, the company announced that over the next five years it would invest $125 million it expects in refunds resulting from federal tax reform in significant initiatives that will drive improvements in health care in several areas, including behavioral health, substance abuse prevention and addiction and recovery. The company launched its first program to stem prescription drug abuse in 1999.</p> <p>“While the results are encouraging, we are faced with daily reminders that fully understanding and combating this public health crisis requires greater collaboration and engagement at virtually every level and Horizon is committed to that goal,” said <strong>Kevin P. Conlin</strong>, <strong>Chairman, CEO and President of Horizon BCBSNJ</strong>. “Horizon is devoting a substantial part of the federal tax refund it is getting to increase prevention and treatment, expand community outreach and intensify our multi-faceted, long-term strategy to help our members stay or become addiction-free. We are determined to continue to be a national leader when it comes to winning the fight against opioids.”</p> <p>The report, examining four years of medical and prescription claim data, also found:</p> <ul> <li><em>Horizon BCBSNJ commercially insured members filling at least one opioid prescription annually dropped by 28% bettering the 25% reduction <a href="https://www.bcbs.com/the-health-of-america/reports/the-opioid-epidemic-america-update?utm_source=bcbscom&amp;utm_medium=page&amp;utm_content=&amp;utm_campaign=HoA-opioidleadership">reported</a> nationally by all Blue Cross Blue Shield plans over the same period;</em></li> </ul> <ul> <li><em>Sixty-two percent of Horizon BCBSNJ commercially insured members’ cumulative opioid use in 2017 was within the CDC-recommended dose and duration guidelines up from up from 55% in 2013- the highest nationally among all Blue Cross Blue Shield plans.</em></li> </ul> <ul> <li><em>In 2016, opioid use disorder (OUD) among commercially insured members peaked with slightly more than 7 in 1,000 members diagnosed. This diagnosis rate remained stable in 2017.</em></li> </ul> <p>“It takes a comprehensive, integrated strategy to tackle an epidemic as complex as opioid addiction,” said <strong>Allen Karp, Executive Vice President for Healthcare and </strong>Transformation for Horizon BCBSNJ. “That’s why Horizon’s response to the opioid crisis is far-reaching and encompasses three key areas: Education and Prevention, Treatment and Recovery, and Community Outreach. We are increasing our investment and building strategic, collaborative partnerships in every area to help our members.”</p> <p>Increased treatment and recovery are a major component of Horizon BCBSNJ’s multi-faceted efforts. The company has piloted programs funding recovery and peer support specialists in hospital ER’s to connect patients with substance abuse problems to treatment, developed an innovated episode of care program for Substance Use Disorders, and expanded access to behavioral health and substance abuse providers.</p> <p>Furthering its longstanding commitment to combat New Jersey’s opioid crisis, in November 2017, Horizon BCBSNJ signed on to Shatterproof’s national coalition of 16 health insurance companies agreeing to adopt eight “National Principles of Care” for the treatment of addiction that will improve outcomes and save lives.</p> <p>“By leveraging best-practice education and preventive interventions that target at-risk members and prescribers, Horizon has been able to identify, intervene and prevent the abuse of opioids. We use advanced analytics to better understand what is happening and to stop or prevent abuse,” said <strong>Dr. Tom Graf, Chief Medical Officer for Horizon BCBSNJ</strong>. These programs include:</p> <ul> <li><strong>The Opioid Alert Program</strong>, in which members who meet high thresholds of morphine equivalent dose of opioids are identified and are referred to Horizon’s Behavioral Health or case management program for intervention when appropriate.</li> </ul> <ul> <li><strong>Pharmacy Lock-in Program</strong>, in which members are identified as high-risk for abuse based on the number of duplicate fills for opioid prescriptions at multiple pharmacies, and limits those identified to filling their prescriptions at a single pharmacy. In 2016 alone, Horizon reached out to 12,000 Medicaid members through this program to reduce opioid use prescriptions by 37 percent.</li> </ul> <ul> <li><strong>Prescriber Initiatives.</strong> The program focuses on educating prescribers on how to reduce high-risk behaviors, reduce morphine equivalent dose, access a prescription monitoring program database, and identify high-risk member behaviors.</li> </ul> <p>Horizon has also launched a significant public outreach and engagement program aimed at bolstering educational efforts:</p> <ul> <li>The development with Rutgers University of an opioids toolkit that has been used to help community-based organizations raise opioids awareness including among more than 3,000 middle and high school age children in New Jersey;</li> </ul> <ul> <li>The award-winning Knock Out Opioid Abuse Town Hall series developed with The Partnership for A Drug Free New Jersey. Beginning in April 2017, the two dozen town halls brought together more than 13,000 New Jersey residents in every county and provided them with a comprehensive understanding of the causes and effects of the opioid epidemic. The events included participation from county prosecutors, state legislators, doctors and professionals from the prevention, treatment and recovery fields.</li> </ul> <ul> <li>Established a co-branded partnership with Walgreens for Safe Med Disposal kiosks to increase opportunities to safely remove unused opioids from the community.</li> </ul> <p><strong>About Horizon Blue Cross Blue Shield of New Jersey</strong></p> <p>Horizon Blue Cross Blue Shield of New Jersey, the state's oldest and largest health insurer is a tax-paying, not-for-profit health service corporation, providing a wide array of medical, dental, vision and prescription insurance products and services. Horizon BCBSNJ is leading the transformation of health care in New Jersey by working with doctors and hospitals to deliver innovative, patient-centered programs that reward the quality, not quantity, of care patients receive. Learn more at <a href="http://www.horizonblue.com/">HorizonBlue.com</a>. Horizon BCBSNJ is an independent licensee of the Blue Cross and Blue Shield Association serving more than 3.8 million members.</p> <p class="text-center">###</p> <p><a href="/sites/default/files/2018-07/07-12-18_Opioid_Results_At_A_Glance.pdf">Click here to read the At-a-Glance summary of the Horizon opioids report</a></p> </div> Thu, 12 Jul 2018 20:00:00 +0000 horizonbcbsnj 3959 at https://www.horizonblue.com What’s Causing Your Stomachache? https://www.horizonblue.com/members/wellness/my-health-manager/what%E2%80%99s-causing-your-stomachache <span class="field field--name-title field--type-string field--label-hidden">What’s Causing Your Stomachache?</span> <span class="field field--name-created field--type-created field--label-hidden">Tue, 07/10/2018 - 02:51</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>Stomach discomfort can have many causes, and various conditions can have similar symptoms. Your primary care physician (PCP) or a gastroenterologist can diagnosis you, but you may want to familiarize yourself with some common disorders ahead of your visit.</p> <p><b>Acid Reflux/Gastroesophageal Reflux Disease (GERD)</b><br /> The symptoms of acid reflux (and its chronic version, GERD) include a cough, and pain and burning in your throat, chest and stomach. Your doctor can help you identify your triggers, which may be certain foods, medicine or even stress, and may recommend self-care and diet changes, as well as prescription medicines.</p> <p><b>Crohn’s Disease</b><br /> This chronic inflammatory condition affects the digestive tract, causing abdominal pain, diarrhea (sometimes bloody) and weight loss. Crohn’s can be managed with lifestyle changes and prescription medicines.</p> <p><b>Inflammatory Bowel Disease</b><br /> Inflammatory bowel disease can cause symptoms such as abdominal cramps, bloody diarrhea, fever and weight loss. Prescription medicines, as well as diet changes and low-impact exercise, may be able to help manage the condition.</p> <p><b>Irritable Bowel Syndrome (IBS)</b><br /> IBS affects mostly women, and what causes it is unknown. Symptoms include diarrhea, constipation and abdominal cramps. You may be advised to make diet and lifestyle modifications, and your doctor may prescribe medicine.</p> <p><b>Ulcerative Colitis</b><br /> Ulcerative colitis is a type of inflammatory bowel disease that causes sores in the colon. Symptoms include abdominal pain and diarrhea (sometimes bloody). Treatment may be a combination of over-the-counter and prescription medicines.</p> <p><b>Need Help Finding a Doctor?</b><br /> Horizon Blue Cross Blue Shield of New Jersey wants to help you get the care you need. To find an in-network PCP or gastroenterologist, visit <a href="https://doctorfinder.horizonblue.com/">HorizonBlue.com/doctorfinder</a>.</p> <p>Always talk with your doctor before making any changes to your exercise or diet.</p> <p>Sources: WebMD®, Healthline</p> </div> Tue, 10 Jul 2018 06:51:25 +0000 horizonbcbsnj 3958 at https://www.horizonblue.com