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Phone scam targeting BCBSA members

horizonbcbsnj — Mon, 15 Apr 2019 13:51:10 +0000

Phone scam targeting BCBSA members Mon, 04/15/2019 - 09:51

Please be aware of a phone scam using “caller ID spoofing” to impersonate the Blue Cross Blue Shield Association. The number in the caller ID may appear as 1-888-630-2583. If you receive a phone call from this number, it is likely fraudulent or malicious. Horizon BCBSNJ will never call you directly to ask you to divulge personal information. When in doubt, hang up and call the number on the back of your Member ID card. If you are not a member call the BCBSA Report Fraud Hotline at 1-877-327-2583.Please visit the Blue Cross Blue Shield Association web site for more information.

Surgical and Implantable Device Program to Include Cardiac Services

horizonbcbsnj — Mon, 15 Apr 2019 08:59:27 +0000

Surgical and Implantable Device Program to Include Cardiac Services Mon, 04/15/2019 - 04:59

Effective July 15, 2019, Horizon BCBSNJ will expand our Surgical and Implantable Device Management Program, administered by TurningPoint Healthcare Solutions, LLC (TurningPoint), to include Prior Authorization & Medical Necessity Determination (PA/MND) reviews for certain cardiac services, many of which may require the use of an implantable device.

TurningPoint will conduct PA/MND reviews of certain cardiac services to:

Determine medical necessity of the services to be provided
Ensure appropriate conservative therapies are attempted prior to invasive procedures
Help to ensure that the most appropriate surgery is performed in the most appropriate setting using the most appropriate device(s)
Help to improve provider best practices

TurningPoint will accept requests for PA/MND starting on July 1, 2019, for any in-scope cardiac procedures to be performed on or after July 15, 2019.

Some of the most common cardiac surgical procedures subject to PA/MND review under this program include:

Implantable Cardioverter Defibrillators

Pacemaker (Single Chamber)

Pacemaker (Dual Chamber)

Pacemaker (Leadless)

Stent (Angioplasty & Endovascular)

Stent (Drug Eluting)

Places of service included in this program

TurningPoint will conduct PA/MND reviews for services rendered in the following settings:

Inpatient
Outpatient
Ambulatory Surgical Center
Office setting

TurningPoint will not conduct PA/MND reviews of services rendered in the Emergency Room or an observation setting.

Members included in this program

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

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

Submitting a PA/MND request to TurningPoint

There are three ways you can request a PA/MND for a cardiac service:

Log on to NaviNet®, select Horizon BCBSNJ from the My Health Plans menu, and:
- Mouse over Referrals & Authorization and select TurningPoint PA/MND Requests
- Select Requests within the TurningPoint menu bar or click the Add Request shortcut
If you do not have access to NaviNet, you can submit a request via TurningPoint’s web portal at myturningpoint-healthcare.com. You must register to obtain access credentials by calling TurningPoint at 1-833-436-4083, Monday through Friday between 8 a.m. and 5 p.m., Eastern Time.
Call TurningPoint at 1-833-436-4083 during the hours noted above.

Review the information TurningPoint requires for a PA/MND request.

Provider responsibilities

Physicians
Physicians are responsible for requesting PA/MND review from TurningPoint

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 prior to providing cardiac services included in this program to ensure that services will be considered medically necessary.

Hospitals and Ambulatory Surgery Centers

Rendering hospitals and ambulatory surgical centers are encouraged to call TurningPoint at 1-833-436-4083 to confirm that a PA/MND has been obtained.

TurningPoint will provide authorization and pre-service PA/MND determination notifications to facilities if they are made aware of the appropriate persons/departments to receive such notification. Please call TurningPoint at 1-833-436-4083 to provide contact information to receive PA/MND determination notifications.

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.

Medical policy criteria and guidelines
TurningPoint manages and maintains the medical policy criteria and guidelines used to conduct PA/MND reviews as part of this program expansion.

Program details and information
Information about this program including the following program resources are available.

Questions?
If you have any questions, call TurningPoint at 1-833-436-4083.

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).

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 1-800-676-2583.

³The 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.

NaviNet® is a registered trademark of NaviNet, Inc.

TurningPoint Healthcare Solutions, LLC supports Horizon Blue Cross Blue Shield of New Jersey in the administration and utilization management review of certain 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.

Additional Member Plans to be Included as part of our Surgical and Implantable Device Management Program for Orthopedic Surgeries

horizonbcbsnj — Mon, 15 Apr 2019 06:22:40 +0000

Additional Member Plans to be Included as part of our Surgical and Implantable Device Management Program for Orthopedic Surgeries Mon, 04/15/2019 - 02:22

Beginning July 15, 2019, the Surgical and Implantable Device Management program for orthopedic services will also apply to members enrolled in Horizon BCBSNJ Medicare Advantage plans.

Through this specialty utilization management program, which Horizon BCBSNJ collaborates with TurningPoint Healthcare Solutions LLC (TurningPoint), TurningPoint conducts Prior Authorization & 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:

Inpatient
Outpatient
Ambulatory Surgical Center
Physician’s Office

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.

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.

View more about this program, including a full listing of the procedures and CPT® codes 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.

Questions?

Horizon BCBSNJ values your participation in our network and the care you provide to our members. If you have any questions, call 1-833-436-4083 Monday through Friday between 8 a.m. and 5 p.m., Eastern Time.

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).

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.

CPT® is a registered trademark of the American Medical Association.
NaviNet® is a registered trademark of NaviNet, Inc.
TurningPoint Healthcare Solutions, LLC supports Horizon Blue Cross Blue Shield of New Jersey in the administration and utilization management review of certain 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.

April is National Donate Life Month

horizonbcbsnj — Thu, 04 Apr 2019 07:23:21 +0000

April is National Donate Life Month Thu, 04/04/2019 - 03:23

April is National Donate Life Month. During this month and throughout the year, people are encouraged to register as organ and tissue donors. A single organ and tissue donor can save eight lives and restore health to over 75 others.¹Right now, more than 114,000 people nationwide are waiting for a life-saving organ transplant.²

Consider registering to help save a life – it only takes a few minutes!

Horizon BCBSNJ is required by law to send you information about organ and tissue donation and registration.

If you live in northern or central New Jersey, contact:

New Jersey Sharing Network
691 Central Avenue
New Providence, NJ 07974
1-800-742-7365
NJSharingNetwork.org

If you live in southern New Jersey, contact:

Gift of Life Donor Program
401 North 3rd Street
Philadelphia, PA 19123
1-800-DONORS-1 (1-800-366-6771)
Donors1.org

EC003181 (0419)

¹Source: NJSharingNetwork.org

²Source: Donors1.org

Orthopedic Services

horizonbcbsnj — Wed, 03 Apr 2019 09:06:06 +0000

Orthopedic Services Wed, 04/03/2019 - 05:06

Horizon BCBSNJ collaborates with TurningPoint to administer PA/MND review for certain orthopedic services, many of which require the use of an implantable device.

Review the procedures subject to PA/MND as part of our Surgical and Implantable Device Management Program for Orthopedic Services.

Members included in this program for orthopedic services

TurningPoint will conduct PA/MND reviews of services included in the scope of this program to be provided to members enrolled in the following plans/programs:

Horizon BCBSNJ fully insured plans/products including those members enrolled in fully insured plans that include BlueCard® benefits for care received outside of our local service area (i.e., all NJ counties, the contiguous counties in DE, NY and PA, as well as Lehigh County, PA).
Beginning July, 1, 2019, TurningPoint will also perform PA/MND review of services to be rendered July, 15, 2019 and after to members enrolled in Horizon BCBSNJ Medicare Advantage (MA) plans.

Resources

Surgical and Implantable Device Management Program for Orthopedic Services Q & A
Surgical and Implantable Device Management Program Provider Training Manual
Surgical and Implantable Device Management Program for Orthopedic Services Procedure Code Listing

CPT® is a registered trademark of the American Medical Association.
NaviNet® is a registered trademark of NaviNet, Inc.
TurningPoint Healthcare Solutions, LLC supports Horizon Blue Cross Blue Shield of New Jersey in the administration and utilization management review of certain orthopedic and cardiac services for coverage. TurningPoint Healthcare Solutions, LLC is independent from, and not affiliated with Horizon Blue Cross Blue Shield of New Jersey or the Blue Cross and Blue Shield Association.

Cardiac Services

horizonbcbsnj — Wed, 03 Apr 2019 08:52:07 +0000

Cardiac Services Wed, 04/03/2019 - 04:52

TurningPoint will accept requests for PA/MND starting on July 1, 2019, for any in-scope cardiac procedures to be performed on or after July 15, 2019.

Review the procedures subject to PA/MND as part of our Surgical and Implantable Device Management Program for Cardiac Services.

Members included in this program for Cardiac Services

TurningPoint will conduct PA/MND reviews of services to be provided to members enrolled in the following plans/programs:

Horizon BCBSNJ fully insured plans/products, including those plans that include BlueCard® benefits for care received outside of our local service area (i.e., all NJ counties, the contiguous counties in DE, NY and PA, as well as Lehigh County, PA)

You can determine member eligibility and benefits by calling the phone number on the back to the member’s ID card. For BlueCard benefit inquiries call 1-800-676-2583.

TurningPoint will NOT conduct PA/MND reviews of services to be provided to members enrolled in self-insured Administrative Services Only (ASO) plans as part of this program.

Resources

Surgical and Implantable Device Management Program for Cardiac Services Q & A
Surgical and Implantable Device Management Program Provider Training Manual
Surgical and Implantable Device Management Program for Cardiac Services Procedure Code Listing

Quarterly Claim Editing Update: Second Quarter 2019

horizonbcbsnj — Fri, 29 Mar 2019 14:05:45 +0000

Quarterly Claim Editing Update: Second Quarter 2019 Fri, 03/29/2019 - 10:05

On or about May 1, 2019, Horizon Blue Cross Blue Shield of New Jersey will implement an update to our claim editing rules and processes.

We encourage you to review details of this update in our Quarterly Claim Editing Update Report

The changes noted in this report will be implemented on or about May 1, 2019.

The effective date of the changes noted in this report will be April 1, 2019 (unless otherwise specified in the report). Changes noted in this report will apply to all claims finalized on and after our implementation date.¹

Read more about our Claim Editing Policies.

If you have questions, call a Physician Services representative at 1-800-624-1110 or an Institutional Services representative at 1-888-666-2535, Monday through Friday, between 8 a.m. and 5 p.m., Eastern Time.

¹Claims 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.

Clear Claim Connection™

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®.

To access Clear Claim Connection, log in to NaviNet.net and:

Select Horizon BCBSNJ from the My Health Plans menu.
Mouse over Claim Management.
Click Clear Claim Connection.

NaviNet® is a registered trademark of NaviNet, Inc.

Medical Policy Revision: Intravenous Antibiotic Therapy for Lyme Disease

horizonbcbsnj — Thu, 28 Mar 2019 13:48:41 +0000

Medical Policy Revision: Intravenous Antibiotic Therapy for Lyme Disease Thu, 03/28/2019 - 09:48

Effective June 27, 2019, Horizon BCBSNJ will change the way we consider certain professional claims based on revisions to our medical policy, Intravenous Antibiotic Therapy for Lyme Disease.

Access our Medical Policy Manual to review this medical policy content.¹

Claims submitted for services provided on and after June 27, 2019 to patients enrolled in Horizon BCBSNJ Commercial, Administrative Services Only (ASO) or Medicare Advantage (MA) plans will be processed as follows:

Based on the submitted diagnosis code(s), information may be requested to help us determine the medical appropriateness of the services represented by HCPCS code J0456.

Following our review of medical record information, the services represented by J0456 code above may be denied as not medically necessary.

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 June 27, 2019.

¹The content of Horizon BCBSNJ medical policies that apply to Horizon BCBSNJ MA plans may include reference to pertinent National Coverage Determinations (NCDs) and/or Local Coverage Determinations (LCDs). We follow Centers for Medicare & Medicaid Services (CMS) guidelines, NCDs and/or LCDs in our processing of claims for services provided to our MA members. For those services where no LCD or NCD exists, claims for MA members will be processed based on our policy guidelines.

Medical Policy Revision: Non-Invasive Home Positive Pressure Ventilation in Adults

horizonbcbsnj — Thu, 28 Mar 2019 13:39:32 +0000

Medical Policy Revision: Non-Invasive Home Positive Pressure Ventilation in Adults Thu, 03/28/2019 - 09:39

Effective June 27, 2019, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain claims based on revisions to our medical policy, Non-Invasive Home Positive Pressure Ventilation in Adults.

Access our Medical Policy Manual to review this medical policy content.¹

Regardless of the submitted diagnosis code(s), claims submitted for services provided on and after June 27, 2019 will be processed as noted below.

Information will be requested to help us determine the medical appropriateness of the services represented by HCPCS code E0465 on claims for services provided to patients enrolled in Horizon BCBSNJ commercial, Administrative Services Only (ASO) and Medicare Advantage (MA) plans.

Following our review of medical record information, the services represented by E0465 may be denied as not medically necessary.

Information will be requested to help us determine the medical appropriateness of the services represented by HCPCS code E0467 submitted on claims for services provided to patients enrolled in Horizon BCBSNJ MA plans.

Following our review of medical record information, the services represented by E0467 may be denied as not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member based on a national coverage determination or local coverage determination.

The services represented by HCPCS code E0467 included on claims for services provided to patients enrolled in Horizon BCBSNJ commercial or ASO plans will be denied as an experimental/investigational, non-covered service.

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 June 27, 2019.

CPT® is a registered mark of the American Medical Association.

Medical Policy Update: Continuous Passive Motion Device

horizonbcbsnj — Wed, 27 Mar 2019 17:37:40 +0000

Medical Policy Update: Continuous Passive Motion Device Wed, 03/27/2019 - 13:37

Effective April 29, 2019, Horizon BCBSNJ will change the way we consider certain professional claims for services provided to members enrolled in Horizon BCBSNJ Medicare Advantage (MA) plans based on updates to our medical policy, Continuous Passive Motion Device.

Access our Medical Policy Manual to review this medical policy content.¹

Claims submitted for services provided on and after April 29, 2019 to patients enrolled in Horizon BCBSNJ MA plans will be processed as follows:

Based on the submitted diagnosis code(s), information may be requested to help us determine the medical appropriateness of the services represented by HCPCS code E0935.
Following our review of medical record information, the services represented by HCPCS code E0935 may be denied as not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member based on a national coverage determination or local coverage determination.

¹ The content of Horizon BCBSNJ medical policies that apply to Horizon BCBSNJ MA plans may include reference to pertinent National Coverage Determinations (NCDs) and/or Local Coverage Determinations (LCDs). We follow Centers for Medicare & Medicaid Services (CMS) guidelines, NCDs and/or LCDs in our processing of claims for services provided to our MA members. For those services where no LCD or NCD exists, claims for MA members are processed based on our policy guidelines.

Intravenous Antibiotic Therapy for Lyme Disease

horizonbcbsnj — Wed, 27 Mar 2019 16:26:08 +0000

Intravenous Antibiotic Therapy for Lyme Disease Wed, 03/27/2019 - 12:26

Medical policy type

Revised

Third Party URL

https://services3.horizon-bcbsnj.com/hcm/MedPol2.nsf/MedicalPolicies/TKEN-6SKN78

Medical Policy Update: Bone Mineral Density Studies and Vertebral Fracture Assessment With Densitometry

horizonbcbsnj — Wed, 27 Mar 2019 16:22:43 +0000

Medical Policy Update: Bone Mineral Density Studies and Vertebral Fracture Assessment With Densitometry Wed, 03/27/2019 - 12:22

Effective April 29, 2019, Horizon BCBSNJ will change the way we consider certain professional claims based on revisions to our medical policy, Bone Mineral Density Studies and Vertebral Fracture Assessment With Densitometry.

Access our Medical Policy Manual to review this medical policy content.¹

Claims submitted for services provided on and after April 29, 2019 to members enrolled in Horizon BCBSNJ Medicare Advantage (MA) plans will be processed as follows.

Regardless of the submitted diagnosis code(s), information will be requested to help us determine the medical appropriateness of the services represented by CPT® code 76977 or HCPCS code G0130.
Following our review of medical record information, the services represented by the codes above may be denied as not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, based on a national coverage determination or local coverage determination.

CPT® is a registered trademark of the American Medical Association.

Home Positive Pressure Ventilation in Adults

horizonbcbsnj — Wed, 27 Mar 2019 16:20:58 +0000

Home Positive Pressure Ventilation in Adults Wed, 03/27/2019 - 12:20

Medical policy type

Revised

Third Party URL

https://services3.horizon-bcbsnj.com/hcm/MedPol2.nsf/MedicalPolicies/RFMI-AARNK7

Ixabepilone (Ixempra)

horizonbcbsnj — Wed, 27 Mar 2019 16:15:10 +0000

Ixabepilone (Ixempra) Wed, 03/27/2019 - 12:15

Medical policy type

New

Third Party URL

https://services3.horizon-bcbsnj.com/hcm/MedPol2.nsf/MedicalPolicies/SSHH-B9YLC4

Medical Policy Revision: Histone Deacetylase Inhibitor(s) [Romidepsin (Istodax®)]

horizonbcbsnj — Mon, 25 Mar 2019 19:11:09 +0000

Medical Policy Revision: Histone Deacetylase Inhibitor(s) [Romidepsin (Istodax®)] Mon, 03/25/2019 - 15:11

Effective June 24, 2019, Horizon BCBSNJ will change the way we consider certain professional claims based on revisions to our medical policy, Histone Deacetylase Inhibitor(s) [Romidepsin (Istodax®)].

Access our Medical Policy Manual to review this medical policy content.¹

Claims submitted for services provided on and after June 24, 2019 to patients enrolled in Horizon BCBSNJ commercial, Administrative Services Only (ASO) or Medicare Advantage (MA) plans will be processed as follows.

For services provided to patients 18 years of age or older:

Based on the submitted diagnosis code(s), information may be requested to help us determine the medical appropriateness of the administration of drugs represented by HCPCS code J9315. Following our review of medical record information, the code above may be denied as an experimental/investigational, non-covered service.

For services provided to patients under 18 years of age:

Regardless of the submitted diagnosis code(s), the administration of drugs represented by HCPCS code J9315 will be denied as an experimental/investigational, non-covered service.

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 June 24, 2019.

Balloon Dilation of the Eustachian Tube

horizonbcbsnj — Fri, 22 Mar 2019 18:30:52 +0000

Balloon Dilation of the Eustachian Tube Fri, 03/22/2019 - 14:30

Medical policy type

New

Third Party URL

https://services3.horizon-bcbsnj.com/hcm/MedPol2.nsf/MedicalPolicies/RFMI-AWMJ9M

Genetic Testing for Inherited Thrombophilias

horizonbcbsnj — Fri, 22 Mar 2019 18:26:28 +0000

Genetic Testing for Inherited Thrombophilias Fri, 03/22/2019 - 14:26

Medical policy type

Revised

Third Party URL

https://services3.horizon-bcbsnj.com/hcm/MedPol2.nsf/MedicalPolicies/RFMI-8EUH8P

Histone Deacetylase Inhibitor(s) [Romidepsin (Istodax®)]

horizonbcbsnj — Fri, 22 Mar 2019 18:22:58 +0000

Histone Deacetylase Inhibitor(s) [Romidepsin (Istodax®)] Fri, 03/22/2019 - 14:22

Medical policy type

Revised

Third Party URL

https://services3.horizon-bcbsnj.com/hcm/MedPol2.nsf/MedicalPolicies/KKPR-7FHTFB

Medical Policy Implementation: Balloon Dilation of the Eustachian Tube

horizonbcbsnj — Fri, 22 Mar 2019 17:34:07 +0000

Medical Policy Implementation: Balloon Dilation of the Eustachian Tube Fri, 03/22/2019 - 13:34

Effective April 22, 2019, Horizon BCBSNJ will implement a new medical policy, Balloon Dilation of the Eustachian Tube. We encourage you to access our Medical Policy Manual to review this medical policy content.¹

This policy’s criteria and guidelines address our position on balloon dilation of the eustachian tube for the treatment of members with chronic eustachian tube dilatory dysfunction.

The implementation of this policy will not result in a material adverse change to how we currently process claims for services provided to your patients enrolled in Horizon BCBSNJ commercial, Administrative Services Only (ASO) or Medicare Advantage (MA) plans.

Medical Policy Revision: Genetic Testing for Inherited Thrombophilias

horizonbcbsnj — Fri, 22 Mar 2019 17:29:51 +0000

Medical Policy Revision: Genetic Testing for Inherited Thrombophilias Fri, 03/22/2019 - 13:29

Effective April 22, 2019, Horizon BCBSNJ will revise the criteria and guidelines of our medical policy, Genetic Testing for Inherited Thrombophilias. We encourage you to access our Medical Policy Manual to review this medical policy content.¹

The revisions to be implemented include a change in our position on MTHFR variant analysis as well as changes to the medically necessary indications related to Factor II/Prothrombin testing and Factor V Leiden testing.

This policy revision will not result in any material adverse change to how we currently process claims for services provided to your patients enrolled in Horizon BCBSNJ commercial, Administrative Services Only (ASO) or Medicare Advantage (MA) plans.

Medical Policy Revision: Bio-Engineered Skin and Soft Tissue Substitutes

horizonbcbsnj — Thu, 14 Mar 2019 13:46:59 +0000

Medical Policy Revision: Bio-Engineered Skin and Soft Tissue Substitutes Thu, 03/14/2019 - 09:46

Effective June 14, 2019, Horizon BCBSNJ will change the way we consider certain professional claims based on revisions to our medical policy, Bio-Engineered Skin and Soft Tissue Substitutes.

Access our Medical Policy Manual to review this medical policy content.

Claims submitted for services provided on and after June 14, 2019 will be processed as follows:

Regardless of the submitted diagnosis code(s), information will be requested to help us determine the medical appropriateness of the injectables or skin substitutes represented by the submission of HCPCS codes Q4103 or Q4104 on claims for services provide to patients enrolled in Horizon BCBSNJ commercial or Administrative Services Only plans.

Following our review of medical record information, the codes above may be denied as experimental/investigational, noncovered services.

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 June 14, 2019.

Medical Policy Revision: Capsaicin 8% patch (Qutenza)

horizonbcbsnj — Thu, 14 Mar 2019 13:39:00 +0000

Medical Policy Revision: Capsaicin 8% patch (Qutenza) Thu, 03/14/2019 - 09:39

Effective June 14, 2019, Horizon BCBSNJ will change the way we consider certain professional claims based on revisions to our medical policy, Capsaicin 8% patch (Qutenza).

Access our Medical Policy Manual to review this medical policy content.¹

Claims submitted for services provided on and after June 14, 2019 to patients enrolled in Horizon BCBSNJ commercial, Administrative Services Only (ASO) or Medicare Advantage (MA) plans will be processed as follows.

For services provided to patients age 18 years and older:

Based on the submitted diagnosis code(s), information may be requested to help us determine the medical appropriateness of the services represented by the HCPCS code J7336. Following our review of medical record information, the code above may be denied as not medically necessary.
Based on the submitted diagnosis code(s), the services represented by HCPCS code J7336 may be denied as experimental/investigational, non-covered services.

For services provided to patients under 18 years of age:

Regardless of the submitted diagnosis code(s), the service represented by HCPCS code J7336 will be denied as an experimental/investigational, non-covered service.

CPT® is a registered mark of the American Medical Association.

Capsaicin 8% patch (Qutenza)

horizonbcbsnj — Wed, 13 Mar 2019 20:04:50 +0000

Capsaicin 8% patch (Qutenza) Wed, 03/13/2019 - 16:04

Medical policy type

Revised

Third Party URL

https://services3.horizon-bcbsnj.com/hcm/MedPol2.nsf/MedicalPolicies/KKPR-883KKV

Bioengineered Skin and Soft Tissue Substitutes

horizonbcbsnj — Wed, 13 Mar 2019 20:00:14 +0000

Bioengineered Skin and Soft Tissue Substitutes Wed, 03/13/2019 - 16:00

Medical policy type

Revised

Third Party URL

https://services3.horizon-bcbsnj.com/hcm/MedPol2.nsf/MedicalPolicies/RFMI-9TFMS4

Blue Review March 2019

horizonbcbsnj — Wed, 13 Mar 2019 06:55:31 +0000

Blue Review March 2019 Wed, 03/13/2019 - 02:55

Home Feed

Phone scam targeting BCBSA members

Surgical and Implantable Device Program to Include Cardiac Services

Additional Member Plans to be Included as part of our Surgical and Implantable Device Management Program for Orthopedic Surgeries

April is National Donate Life Month

Orthopedic Services

Cardiac Services

Quarterly Claim Editing Update: Second Quarter 2019

Medical Policy Revision: Intravenous Antibiotic Therapy for Lyme Disease

Medical Policy Revision: Non-Invasive Home Positive Pressure Ventilation in Adults

Medical Policy Update: Continuous Passive Motion Device

Intravenous Antibiotic Therapy for Lyme Disease

Medical Policy Update: Bone Mineral Density Studies and Vertebral Fracture Assessment With Densitometry

Home Positive Pressure Ventilation in Adults

Ixabepilone (Ixempra)

Medical Policy Revision: Histone Deacetylase Inhibitor(s) [Romidepsin (Istodax®)]

Balloon Dilation of the Eustachian Tube

Genetic Testing for Inherited Thrombophilias

Histone Deacetylase Inhibitor(s) [Romidepsin (Istodax®)]

Medical Policy Implementation: Balloon Dilation of the Eustachian Tube

Medical Policy Revision: Genetic Testing for Inherited Thrombophilias

Medical Policy Revision: Bio-Engineered Skin and Soft Tissue Substitutes

Medical Policy Revision: Capsaicin 8% patch (Qutenza)

Capsaicin 8% patch (Qutenza)

Bioengineered Skin and Soft Tissue Substitutes

Blue Review March 2019

blue-review-march-2019.pdf