TurningPoint Healthcare Solutions LLC manages prior authorizations for:
- Orthopedic procedures
- Spinal procedures
This requirement applies to:
- Blue Cross Blue Shield of Michigan commercial fully insured groups, select self-funded groups and members with individual coverage*
Note: This includes UAW Retiree Medical Benefits Trust non-Medicare members, for dates of service on or after May 31, 2021
- Medicare Plus BlueSM members
- For information about musculoskeletal services for BCN commercial and BCN AdvantageSM members, see the BCN Musculoskeletal Services page.
- TurningPoint also manages prior authorizations for pain management procedures; see the Blue Cross Pain Management Services page for details.
- Musculoskeletal procedure codes that require authorization by TurningPoint (PDF)
- Musculoskeletal procedure code substitutions for orthopedic and spinal surgeries (PDF)
- TurningPoint Documentation Guideline (PDF)
- TurningPoint Coding Requirements (PDF)
- Musculoskeletal procedure authorizations: Frequently asked questions for providers (PDF)
- Musculoskeletal procedure authorizations: Quick reference for providers (PDF)
- Determining whether procedure codes require prior authorization for a member (PDF)
- TurningPoint Provider Training Manual (PDF)
- Musculoskeletal services: For authorization determinations (PDF) — Includes information about the utilization management program
TurningPoint fax forms for prior authorization and postservice change requests
Training for the TurningPoint program
We offer provider training. To learn more, see our Training Tools page.
*To determine whether you need to submit prior authorization requests for Blue Cross commercial members, see the document titled Determining whether procedure codes require prior authorization for a member (PDF).
TurningPoint Healthcare Solutions LLC is an independent company that manages prior authorizations for musculoskeletal surgical and related procedures for Blue Cross Blue Shield of Michigan and Blue Care Network.