Providers must obtain authorization from TurningPoint Healthcare Solutions LLC for:
- Orthopedic procedures
- Pain management procedures
- Spinal procedures
This is requirement applies to:
- Blue Cross 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 Blue members
For information about musculoskeletal services for BCN commercial and BCN AdvantageSM members, see the BCN Musculoskeletal Services page.
Resources and forms for the TurningPoint musculoskeletal surgical quality and safety management program
Refer to the following resources for more information:
- 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 Blue Cross commercial members require prior authorization for musculoskeletal surgeries and related procedures (PDF)
- TurningPoint Provider Training Manual (PDF)
- Musculoskeletal services: For authorization determinations (PDF) - Includes information about the utilization management program
- Pain management: For non-hospice palliative care and for musculoskeletal-related pain management procedures (PDF) - Includes information about care management and utilization management programs
- Surgeries: For decision support and authorization determinations (PDF) - Includes information about our care management and utilization management programs
- Joint and spine procedures authorization request form (PDF)
- Pain management: Epidural steroid injections authorization request form (PDF)
- Pain management: Facet joint injections authorization request form (PDF)
- Pain management: Neuroablation procedures authorization request form (PDF)
- Pain management: Sacroiliac joint injections authorization request form (PDF)
- Postservice change request form (PDF)
To determine which pain management form to submit, see the “Pain management” section of the Musculoskeletal procedure codes that require authorization by TurningPoint document (PDF). This document specifies which procedure codes fall within each pain management category.
Training for the TurningPoint program – For the July 1, 2020, and the Jan. 1, 2021 implementation
From our dedicated provider training site,** you can access the webinar recordings and the PDFs of the webinar presentations for the professional provider training, the facility provider training and the portal training.
To find the TurningPoint trainings, search on “TurningPoint” and then click the Courses tab.
To request access to the provider training site:
- Click here to register.**
- Complete the registration. We recommend using the same email you use to communicate with Blue Cross for provider-related needs. This will become your login ID.
- Follow the link to log in.**
If you need assistance creating your login ID or navigating the site, email ProviderTraining@bcbsm.com.
*To determine whether you need to submit prior authorization requests for Blue Cross commercial members, see the document titled Determining whether Blue Cross commercial members require prior authorization for musculoskeletal surgeries and related procedures (PDF).
**Clicking this link means that you're leaving the Blue Cross Blue Shield of Michigan and Blue Care Network website. While we recommend this site, we're not responsible for its content.