Horizon Blue Cross Blue Shield of NJ (2024)

The New Jersey Prescription Monitoring Program (NJPMP) is an important component of the New Jersey Division of Consumer Affairs' effort to halt the abuse and diversion of prescription drugs. The NJPMP is a statewide database that collects prescription data on Controlled Dangerous Substances (CDS), Human Growth Hormone and gabapentin dispensed in outpatient settings in New Jersey, and by out-of-state pharmacies dispensing in New Jersey.¹

According to the American Dental Association (ADA), dentists should use prescription monitoring programs to promote the appropriate use of CDS for legitimate medical purposes, while deterring the misuse, abuse and diversion of these substances.²The ADA also states that nonsteroidal anti-inflammatory drugs (NSAIDS) have been shown to be more effective at reducing pain than opioid analgesics, and are therefore recommended as the first-line therapy for acute pain management.³According to the 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain, non-opioid therapies are at least as effective as opioids for many common acute pain conditions, including dental pain.⁴When considering prescribing opioids, dentists should conduct a medical and dental history to determine current medications, potential drug interactions and any history of substance abuse.³

In certain cases, providers are required to access the NJPMP before prescribing medicine to their patients, including:¹

• The first time a Schedule II controlled dangerous substance, or any opioid, is prescribed
• Every three months, if therapy is to be continued
• Any time it is suspected the patient is seeking CDS for misuse, abuse or diversion

All providers and pharmacists who are licensed by the state of New Jersey and whose licenses are in good standing with their licensing board are able to access the NJPMP to provide better-informed patient care.

What You Should Do

You can register for the NJPMP at: newjersey.pmpaware.net/identities/new. To create your account, enter your email address as the user ID and create a password, then enter your professional and personal information. Detailed instructions are available by clicking on Registration Process Tutorial.

References:
<sup><sub>1.NJ Consumer Affairs. NJ Prescription Monitoring Program Frequently Asked Questions, njconsumeraffairs.gov/pmp/Pages/FAQ.aspx.
2. American Dental Association. American Dental Association’s Statement on the Use of Opioids in the Treatment of Dental Pain, ada.org/about/governance/current-policies.
3. American Dental Association. Oral Analgesics for Acute Dental Pain, ada.org/resources/research/science-and-research-institute/oral-health-topics/oral-analgesics for-acute-dental pain#:~:text=Nonsteroidal%20anti%2Dinflammatory %20drugs%20(NSAIDs,therapy%20for%20acute%20pain%20management.
4. Centers for Disease Control and Prevention. 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain, cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm.</sub></sup>

With nearly 700,000 members and counting, we help dental professionals build their practices by giving them access to new patients through our Traditional and PPO Networks and our affiliation with the National Dental GRID.

Benefit From a Traditional Network You Can Grow With
By participating in our Traditional Network, you can maintain your existing patients and have access to:

• More than 10,000 businesses, school boards, municipalities and other dental benefits clients.
• Direct reimbursem*nt for covered services — this can help improve your cash flow and minimize administrative costs and time. Plus, we accept claims and attachments electronically.
• Clear, personalized communications and dedicated Network Representatives to work with you.
• The National Dental GRID, which means you can treat patients from neighboring states who have a participating Blue Cross Blue Shield plan.

Enroll in a PPO Network to Give You More Options
When you join the Traditional Network you can also enroll in our PPO Network for more patient growth opportunities. This give you access to 227,000 subscribers in the Federal Employees Health Benefits Program (FEHBP), along with its new comprehensive voluntary plan, and other employer groups' subscribers.

How to Join Our Dental Network
To join or for more information, contact a Network Representative in your county.

Reminder to Follow American Dental Association (ADA) Guidelines: Submit Medical Codes on Claims

When submitting claims, make sure you submit ICD-10 medical codes as explained in sections 34 and 34A of the ADA claim form instructions.

When you submit the appropriate ICD-10 medical codes, you help capture your Horizon patients' full picture of health. This helps improve their health outcomes and ensure they get the comprehensive health care they need.

It is important that you always enter accurate coding and thorough clinical documentation at every patient visit to help:

• Determine a patient's health status and chronic conditions annually
• Support diagnoses codes submitted on claims

When information is missing in the documentation, it can cause treatment errors and misdiagnoses. Be sure that diagnoses identified during patient encounters are reflected in all claim submissions, which helps your patients get the best continuum of medical care, including access to care management programs that may be available to them.

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