What you need to know
Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ) will begin conducting Prior Authorization & Medical Necessity Determination (PA/MND) reviews for certain specialized orthopedic surgeries, many of which may require the use of an implantable device.
Beginning December 3, TurningPoint Healthcare Solutions, in coordination with Horizon BCBSNJ, will conduct Prior Authorization & Medical Necessity Determination reviews (PA/MND) for the following surgeries that are performed in an inpatient, outpatient, ambulatory surgical center or physician office setting:
TurningPoint will accept requests for PA/MNDs beginning November 19 for any in-scope orthopedic surgical procedures that are scheduled on or after December 3.
For more information
- Check these answers to Frequently Asked Questions.
- Access a list of procedure codes included in this program.
- Read Horizon’s latest update.
- Contact Terry Manna, senior vice president of Managed Care for Hackensack Meridian Health, at 848-888-4425 or at Terry.Manna@HackensackMeridian.org.