Reminder: Providers must submit authorization requests to TurningPoint for musculoskeletal procedures for most members

As we reported in the November issue of The Record and the November-December issue of BCN Provider News (Page 46), TurningPoint Healthcare Solutions LLC has expanded its surgical quality and safety management program for dates of service on or after Jan. 1, 2021.

You now need to submit authorization requests for orthopedic, pain management and spinal procedures to TurningPoint for the following groups and members:

• Blue Cross commercial — All fully insured groups and select self-funded groups
• Medicare Plus Blue℠ members
• BCN commercial members
• BCN Advantage℠ members

Some important reminders

• Facilities should have an authorization number before scheduling surgery. The ordering physician or provider office must secure the authorization and provide the authorization number to the facility.
• For inpatient professional claims, include only the procedure codes authorized by TurningPoint on claims for musculoskeletal procedures.
• For procedures affected by the Jan. 1 program expansion, TurningPoint began accepting authorization requests on Dec. 1, 2020.
• You have until April 30, 2021, to submit retroactive authorization requests to eviCore healthcare^® for:
• Spinal procedures for Blue Cross’ commercial fully insured groups and Medicare Plus Blue members for dates of service prior to Jan. 1
• Pain management procedures for all Blue Cross commercial fully insured groups, select Blue Cross commercial self-funded groups, all Medicare Plus Blue members, all BCN commercial members and all BCN Advantage members for dates of service prior to Jan. 1

Webinar training
We’ll continue to offer webinar training for providers, facilities and clinical staff. Use the links below to register.

Professional provider training includes information about TurningPoint’s clinical model, operational changes and provider portal.

Facility training includes information about TurningPoint’s clinical model and operational changes and the facility verification process.

Portal training includes information about using the TurningPoint provider portal.

Where to find more information
For more information about TurningPoint, see the following pages on the ereferrals.bcbsm.com website:

• Blue Cross Musculoskeletal Services
• BCN Musculoskeletal Services

To view the lists of codes for which TurningPoint manages authorizations, see Musculoskeletal procedure codes that require authorization by TurningPoint.

For detailed information, see Musculoskeletal procedure authorizations: Frequently asked questions for providers.