19-849 Changes to Prior Authorization Process and Requirements for Musculoskeletal Surgical Procedures
Date: 10/25/19
Changes to Prior Authorization Process and Requirements for Musculoskeletal Surgical Procedures
TurningPoint must approve prior authorization requests for these surgical procedures
On January 1, 2020, certain musculoskeletal inpatient and outpatient surgical procedures will require prior authorization from TurningPoint Healthcare Solutions, LLC, rather than California Health & Wellness Plan (CHWP). The effective date is subject to change pending regulatory approval and providers will be notified if the effective date changes.
This prior authorization change applies to CHWP members ages 21 and over enrolled with a managed care plan but not assigned to a delegated independent practice association (IPA).
Clarification for letter mailed to physicians
Physicians were sent a letter (19-802) on October 16, 2019, that notified them about the change to their contract to submit prior authorization for musculoskeletal surgical procedures to TurningPoint instead of CHWP. Please note, the clarification that the change applies to CHWP members ages 21 and over was not included in the letter.
TurningPoint will accept requests as early as December 15, 2019
Refer to page 2 for musculoskeletal surgical procedures that require prior authorization from TurningPoint.
Contact TurningPoint to submit prior authorization requests
Contact TurningPoint and not CHWP to request approval for musculoskeletal surgical procedures that require prior authorization.
TurningPoint Contacts | |
Telephone | 1-855-332-5898 |
Fax | (949) 774-2254 |
centenecaum@turningpoint-healthcare.com | |
Website | www.myturningpoint-healthcare.com |
Training | Email: providersupport@turningpoint-healthcare.com or contact TurningPoint by telephone at 1-866-422-0800 |
Other operations remain unchanged. As a reminder:
· In accordance with your contract with CHWP, lack of prior authorization approval may result in nonpayment of claims.
· Emergency-related procedures do not require authorization.
Musculoskeletal surgical procedures that require prior authorization
Submit requests for prior authorization to TurningPoint for the following procedures.
Orthopedic surgical procedures (including partial, total and revision surgeries1)
· Acromioplasty and rotator cuff repair · Ankle arthroplasty · Ankle fusion · Anterior cruciate ligament repair · Elbow arthroplasty · Femoroacetabular arthroscopy · Hip arthroplasty · Hip arthroscopy · Hip resurfacing | · Knee arthroplasty · Knee arthroscopy · Knee replacement for unicompartmental or bicompartmental · Osteochondral defect repair · Meniscal repair · Shoulder arthroplasty · Shoulder fusion · Wrist arthroplasty · Wrist fusion |
Spinal surgical procedures (including partial, total and revision surgeries1)
· Disc replacement · Implantable pain pumps · Kyphoplasty or vertebroplasty · Laminectomy/discectomy | · Spinal cord neurostimulator · Spinal decompression · Spinal fusion surgeries |
|
Contact CHWP with questions
Call 1-877-658-0305.
1 Effective January 1, 2020, musculoskeletal surgical procedures require prior authorization from TurningPoint Healthcare
Solutions, LLC.