Update from Trenton

Two of NJPCAC’s priority issues are heating up in Trenton as Legislators tackle an aggressive pre-holiday agenda. The Out of Network issue and the NJPCAC-led initiative to reform New Jersey’s “Codey Act” to allow for value-based/alternative payment model health care are expected to see action. A third issue – Horizon’s OMNIA tiered network product and its impact on hospitals and physicians – has gone dormant. A new issue has also emerged: Horizon’s notice effective December 1, to its reimbursement policy involving site of service differential for surgical CPT codes (10000 through 69999). NJPCAC is in the early stages of deciding how to respond to this new issue. Updates on the Out of Network, Codey Act Reform and OMNIA issues are now available.