Horizon Brief Notes: PA/MND Reviews for Spine Surgery Services Will Transition from eviCore to TurningPoint
Posted on November 1, 2021
See below Brief Notes from Horizon regarding the Musculoskeletal Program for Spine Surgery
Horizon BCBSNJ Brief Notes
PA/MND Reviews of Spine Surgery Services Will Transition from eviCore to TurningPoint
Beginning January 18, 2022, Prior Authorization and/or Medical Necessity Determination (PA/MND) review requests for spine-related services that will be performed on and after February 1, 2022, must be submitted to TurningPoint Healthcare Solutions (TurningPoint). These reviews are currently performed by eviCore. This change will affect Horizon Blue Cross Blue Sheilds of New Jersey’s fully insured business and self-insured accounts that have opted into the Musculoskeletal Program for Spine Surgery.
Quality Care for Our Members
TurningPoint will review PA/MND requests and make clinical decisions based on its policies to help ensure treatment options are clinically appropriate and financially responsible. TurningPoint will support Horizon BCBSNJ’s members and their doctors and other health care professionals to achieve:
What’s Not Changing
In addition, there are no changes for Horizon’s self-insured customers that do not have eviCore’s spine-related services.
1 The transition to TurningPoint for management of spine-related services is subject to the approval of the New Jersey Department of Banking and Insurance. If regulatory approval is not obtained by February 1, 2022, the transition from eviCore to TurningPoint will be delayed, and additional communications will be issued.