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January 2020

TurningPoint to handle authorization requests for musculoskeletal procedures with dates of service on or after June 1 for Medicare Advantage, BCN members

Authorization requests for all surgical procedures related to musculoskeletal conditions scheduled to occur on or after June 1, 2020, need to be submitted to TurningPoint Healthcare Solutions starting May 1, 2020, for Medicare Plus BlueSM PPO, Blue Care Network and BCN AdvantageSM members.

TurningPoint specializes in musculoskeletal utilization management and offers provider-friendly systems with a specialized focus on improving patient outcomes for people receiving procedures such as joint replacements.

Regarding authorized procedures:

  • For procedures that are currently authorized by Blue Cross Blue Shield of Michigan, such as joint replacements, if the date of service is before June 1, 2020, providers should continue to seek authorization through e-referral.
  • If the date of service is on or after June 1, providers should seek authorization through TurningPoint, which will begin receiving authorization requests on May 1, 2020.
  • If there are new codes requiring authorization from TurningPoint that don’t currently require prior authorization, providers will need to request authorization from TurningPoint, but not until May 1, 2020, for dates of service on or after June 1, 2020.

We’ll provide more information about how to submit authorization requests to TurningPoint — and which procedure codes are affected — in future issues of The Record. We’ll also offer training on the new authorization process, and will publish a webinar training schedule so you and your office staff can sign up.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2019 American Medical Association. All rights reserved.