Musculoskeletal services

Providers must obtain authorizations for select musculoskeletal services.

Blue Cross and BCN Utilization Management departments

Blue Cross and BCN Utilization Management departments

For dates of service before July 1, 2020, the Blue Cross and BCN Utilization Management departments manage authorizations for the following procedures and members:

  • Joint procedures for Medicare Plus BlueSM PPO, BCN HMOSM and BCN AdvantageSM members
  • Spine procedures for BCN HMO and BCN Advantage members

eviCore healthcare®

For all dates of service, providers must obtain authorization from eviCore for inpatient and outpatient lumbar spinal fusion surgery for the following members:

  • Blue Cross PPO (commercial) - For all fully insured groups except Michigan Education Special Services Association
  • Medicare Plus Blue PPO

Refer to the following resources for more information:

For information about other services managed by eviCore, see the Blue Cross eviCore-Managed Procedures page or the BCN eviCore-Managed Procedures page.

TurningPoint Healthcare Solutions, LLC

TurningPoint Healthcare Solutions, LLC

For dates of service on or after July 1, 2020, providers must obtain authorization from TurningPoint for the following procedures and members:

  • Joint procedures for Medicare Plus Blue, BCN HMO and BCN Advantage members
  • Spine procedures for BCN HMO and BCN Advantage members

Refer to the following resources for more information:

Forms