Blue Review December 2021
Easily Access Member ID Cards Virtually
Your staff may be in the habit of asking for a physical member ID card to make copies or verify benefit information. Did you know that your patients with Horizon benefits can present a digital ID card? You can be confident that it is a valid proof of coverage and contains all the information you would see on a physical member ID card.
More members are using digital ID cards, which are convenient and easy to access from smartphones using the Horizon Blue app or at HorizonBlue.com.
Accessing Digital Member ID Cards is Easy
You can also view or print a member’s digital ID through NaviNet.
- Select Horizon BCBSNJ within the My Health Plans menu.
- Mouse over Eligibility & Benefits and select Eligibility & Benefits Inquiry.
- Enter your patient’s Horizon member ID number, or their first name, last name and date of birth.
- Click Search.
- Within the member ID card column, select View next to the member’s name.
With digital member ID cards, your practice doesn’t have to rely on scanning or copying cards to verify a patient’s benefits. You can also use the Eligibility and Benefits Cost Share Tool without an ID card.
Watch to Learn More
Watch this video to learn how your office can access digital member ID cards.
Diabetes Screening for People with Schizophrenia or Bipolar Disorder
Research indicates that there is an association between antipsychotic medication and metabolic adverse effects. Over time this can lead to metabolic syndrome, cardiovascular issues and type 2 diabetes. Individuals who are taking an antipsychotic medication may experience an elevation in blood glucose, serum triglyceride and LDL levels and a decrease in HDL level. Weight gain is often reported in those individuals who are prescribed certain antipsychotic medications. However these effects may also be seen without an increase in BMI. Known metabolic risks that occur in those taking antipsychotics would require baseline and periodic monitoring.
Two of the HEDIS® (Healthcare Effectiveness Data and Information Set) performance measures developed by the National Committee for Quality Assurance (NCQA) requires specific annual lab work for those patients who are prescribed an antipsychotic medication. The first measure, Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications (SSD), is targeted towards those age 18 to64 years old. This measure requires that these individuals have either an HbA1C or Glucose test annually. The second measure, Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM), applies to those age 1to17 years old. There are three rates that are reported and monitored for this measure.
- The percentage of children and adolescents on antipsychotics who received blood glucose testing (HbA1C or Glucose test).
- The percentage of children and adolescents on antipsychotics who received cholesterol testing (LDL test).
- The percentage of children and adolescents on antipsychotics who received blood glucose and cholesterol testing (HbA1C or Glucose and LDL test).
With on-going supportive education and medication counseling patients experiencing metabolic side effects can have improved treatment outcomes. Below are some best practice suggestions when working with patients prescribed an antipsychotic medication:
- Obtain patients baseline weight, HbA1C, glucose and lipid levels and monitor regularly.
- Review recent lab work with the patient so they are aware of any changes in their levels.
- Ensure that the patient’s PCP or other involved specialists are aware of their treatment plan.
- Provide lifestyle counseling regarding nutrition and physical activity, if needed.
- Consider making a referral to a dietician or other health care professional.
- Suggest self-help recommendations such as literature, support groups and classes for continuing education.
- Share appropriate informational materials that the patient can give to their support system.
Horizon’s Behavioral Health HEDIS Team is available to assist providers with meeting performance goals. Our Clinical Quality Improvement Liaisons (CQILs) are here to help you by emailing BH_HEDISTeam@HorizonBlue.com.
Early Elective Delivery Mandate applies to SHBP/SEHBP members
In accordance with N.J.S.A. §30:4D-9.2, State Health Benefits Program (SHBP) and School Employees’ Health Benefits Program (SEHBP) benefits do not cover early elective deliveries that are not medically indicated in accordance with established standards of clinical care as provided by the American College of Obstetricians and Gynecologists (ACOG).
As of January 1, 2021, delivery claims for SHBP/SEHBP members have been considered for reimbursement as an eligible delivery claim if submitted with an appropriate ICD-10 diagnosis code that designates weeks of gestation and additional ICD-10, ICD-10 PCS codes that designate a complication during delivery that would make the claim medically necessary to deliver the baby early.
SHBP/SEHBP programs will not consider for reimbursement a delivery claim with a gestational age of less than 39 weeks (38 weeks or less) that does not also include a secondary diagnosis code to support the need for an early delivery.
TurningPoint Surgical and Implantable Device Management Program to Expand to Spine-Related Services
Effective February 1, 2022, in collaboration with TurningPoint Healthcare Solutions LLC. (TurningPoint), our Surgical and Implantable Device Management Program will expand to include certain spine-related services, which will include non-surgical and surgical services that may use an implantable device (“spine-related services”).
Musculoskeletal Program for Spine SurgeryProgram by eviCore healthcare to end
As a result of the TurningPoint program expansion to include spine-related services, effective February 1, 2022, Horizon will sunset spine-related services as part of our Musculoskeletal Program for Spine Surgery, managed by eviCore healthcare (eviCore). Do not submit any requests to eviCore for review of spine-related services to be rendered on and after February 1, 2022. However, eviCore will continue to review pain management services as part of our Musculoskeletal Program.
Let’s Work Together to Improve your Patients’ Experience
Your patients’ opinions of the care they receive greatly affects how they care for themselves. That’s why we’re committed to helping you provide a great experience for your Horizon and Braven℠ Health members. We’ve developed tools and resources, such as the Playbook for Patient Engagement and videos, to help you and your staff enhance your patients’ overall health care experience.
The Playbook for Patient Engagement will help your practice:
- Take patient experience to the next level
- Better coordinate care between care settings
- Ensure patients are prescribed covered medications and understand why, when and how to take them
- Complete preventive and chronic disease screenings and close gaps in care
- Improve key measures on the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey
- Have better health outcomes for your patients
Registration is required to access the Playbook for Patient Engagement. Learn more about the Playbook and the importance of patient experience at HorizonBlue.com/patient-engagement.
We’re here to help
We offer a free Coaching Program to help you and your team adopt best practices that drive optimal outcomes. We also encourage you to work with your Clinical Quality Improvement Liaison to develop strategies to increase patient compliance and outcomes, and share tips that have helped your organization. If you have a value-based contact, they may also have ideas on how to improve performance.
For more information, contact our CAHPS coaching team at 1-888-65 CAHPS (1-888-652-2477) weekdays, from 8 a.m. to 5 p.m., Eastern Time, or email CAHPS@HorizonBlue.com.
Together, we can continue to help your patients achieve their best health.
Working to Improve Behavioral Health in New Jersey
Horizon’s Integrated System of Care (ISC) Program is the first of its kind in New Jersey. Horizon partners with behavioral health providers to care for our members with serious mental illness (SMI) and substance use disorders (SUD). The ISC Provider acts as “Integrator” for all of the ISC members’ care. Each Horizon member who is part of this program is assigned a care coordinator with an ISC provider who assures communication and collaboration among all behavioral, physical, and social determinants of health care providers on behalf of the member, facilitating patient access to all needed services.
The ISC Program provides access to high quality, comprehensive care for patients with serious mental illness and substance use disorders to help them on a path toward recovery. Learn more about the ISC Program and how you can refer a patient for services.
City of New York Retirees Have a New MA PPO Plan
Effective January 1, 2022, approximately 256,000 Medicare-eligible City of New York retirees will change their coverage. These members will transition from Traditional Medicare + Supplement coverage to a Medicare Advantage PPO plan called NYC Medicare Advantage Plus. Retirees may also refer to the new plan as Medicare Advantage Plus or the Alliance
Retirees enrolled in NYC Medicare Advantage Plus will have access to BlueCross BlueShield Medicare Advantage PPO Network Sharing effective January 1, 2022.
New Email Address for Initial Credentialing Submissions
We have created a new email address for providers to submit credentialing applications to join our network(s) and updated all the initial credentialing application forms.
Completed credentialing applications should be submitted to: CredentialingApplicationsPDM@HorizonBlue.com.
Please discontinue use of any old credentialing forms.
Visit the Join our Networks webpage to review details about submitting requests for initial credentialing and to access our revised suite of credentialing forms.
Updating Your Practice’s Information is Easy with Our Provider Data Maintenance Tool
Our Provider Data Maintenance Tool makes it easier to update your demographic information, including your race and ethnicity.
Horizon displays information about practitioner race and ethnicity in our Doctor & Hospital Finder so our members can consider this information as one of the factors when making decisions about in-network care.
Although not required, we encourage practitioners to provide information about their race/ethnicity to help us address racial and ethnic health disparities in the communities we serve by allowing members to select a provider that matches their cultural needs.
Choosing not to disclose practitioner race and ethnicity information has no impact on practitioner credentialing or your participation in our network(s).
To quickly and conveniently update practice or practitioner information on file, your NaviNet Security Officer can sign in to NaviNet to access the Provider Data Maintenance Tool through the Horizon BCBSNJ Plan Central page and:
- Add or delete office locations
- Add or update office email addresses
- Update phone and fax numbers
- Manage practice limitations
- Manage areas of expertise for behavioral health services
- Indicate if you offer telemedicine services
- Provide information about your race/ethnicity
You can make changes to your provider demographic information which we display to your Horizon and Horizon NJ Health patients.
You should also review Initiating Demographic Updates for the complete list of information you need to keep up-to-date.
Access Member Eligibility and Benefits Cost Share Information Online
Our new Eligibility and Benefits Cost Share Estimator on NaviNet® gives you access to medical and behavioral health claim-level member eligibility, benefits and out-of-pocket costs. This tool, available to all providers, provides you with information for your Horizon members enrolled in our Commercial and Medicare Advantage (including Braven℠Health) plans with a member ID number that includes “3HZN.”
With this tool and our other online resources, you no longer need to contact Provider Services or rely on member ID cards to confirm your Horizon member’s eligibility and benefit information. If the member ID number does not include “3HZN,” please continue to call the Provider Services number on the member’s ID card for information.
How to Access the New Tool
Access the Horizon BCBSNJ plan central page on NaviNet, then:
- Select Eligibility and Benefits from the Workflows for this Plan menu
- Click on Cost Share Estimator
- You must continue to contact us for eligibility and cost information for services requiring:
- Authorizations or medical necessity reviews.
- Combined revenue and HCPCS codes.
Please continue to use the Utilization Management Request Tool on NaviNet to submit your authorization and medical necessity review requests.
- Provider Services: 1-800-624-1110, weekdays, 8 a.m. to 5 p.m., ET.
- Institutional Services: 1-888-666-2535, weekdays, 8 a.m. to 5 p.m., ET.
- Behavioral health providers can also email: BHNetworkRelations@HorizonBlue.com. Please include your name, NPI and county.
Technical support: eService Desk at 1-888-777-5075, weekdays, 7 a.m. to 6 p.m., ET.
Medicare Advantage and Braven Health℠ Plan Offerings Are Changing for 2022
We have made changes to the Medicare Advantage plans we offer in Bergen, Essex, Hudson, Middlesex, Monmouth, Ocean, Passaic and Union counties. Horizon Medicare Advantage plans will not be offered in 2022 in these counties. Members may choose a new plan. Members received information about coverage options and what they need to do during the open enrollment period.
Learn more about Braven Health plans.