TurningPoint musculoskeletal authorization program to expand in January

We’ll add Blue Cross Blue Shield of Michigan commercial members to the TurningPoint Healthcare Solutions, LLC musculoskeletal program for spine, pain management and joint replacement surgeries and related procedures for dates of service on or after Jan. 1, 2021. At that time, the program will also expand to include pain management procedures for Blue Care Network commercial, BCN Advantage^SM and Medicare Plus Blue^SM members

In addition, spinal procedures for Medicare Plus Blue members will transition from being managed by eviCore healthcare^® to being managed by TurningPoint.

Providers can begin submitting authorization requests for the expanded procedures starting Dec. 1, 2020, for dates of service on or after Jan. 1, 2021.

In the September Record, we’ll provide information about the procedure codes that are affected by these changes and upcoming webinars for health care providers and their office staff. The information will also appear in a future issue of BCN Provider News.

Background

As reported in the July Record, health care providers should submit authorization requests through TurningPoint for musculoskeletal surgical procedures with a date of service on or after July 1, 2020, for BCN commercial, Medicare Plus Blue and BCN Advantage members. This includes spine and joint replacement surgeries and related procedures.

However, lumbar spinal fusion surgeries for Medicare Plus Blue members will continue to be managed by eviCore through 2020. You can find the codes for these procedures in the Lumbar spinal fusion surgery procedures requiring authorization by eviCore table in the Procedures that require authorization by eviCore healthcare document. The document is located on the ereferrals.bcbsm.com website. To locate it, click on Blue Cross and then on eviCore-Managed Procedures.

For more information

• See the e-referral webpages for Blue Cross and BCN.
• Find procedure codes for orthopedic and spinal procedures managed by TurningPoint on ereferrals.bcbsm.com as follows:
  • Orthopedic
  • Spinal
• Refer to the Frequently asked questions for providers document on our ereferrals.bcbsm.com website.