TurningPoint Healthcare Solutions LLC manages prior authorizations for:

• Orthopedic procedures
• Pain management 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 Blue^SM members

For information about musculoskeletal services for BCN commercial and BCN Advantage^SM members, see the BCN Musculoskeletal Services page.

Resources

• 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
• Pain management: For non-hospice palliative care and for musculoskeletal-related pain management procedures (PDF) - Includes information about care management and utilization management programs

TurningPoint fax forms for prior authorization and postservice change requests

• 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

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.