Reminder: Submit prior authorization requests to TurningPoint for musculoskeletal procedures for most members

For dates of service on or after Jan. 1, 2021, providers must submit prior authorization requests to TurningPoint Healthcare Solutions LLC for orthopedic, pain management and spinal surgical procedures for the following groups and individual members:

• Blue Cross commercial - All fully insured groups, select self-funded groups and all members with individual coverage

  Note: To determine whether you need to submit prior authorization requests for Blue Cross commercial members, see "How do I know if I need to request prior authorization from TurningPoint for members who have coverage through Blue Cross commercial plans?" in the Musculoskeletal procedure authorizations: Frequently asked questions for providers (PDF) document.

• Medicare Plus Blue^SM - All groups and all members with individual coverage
• BCN commercial - All fully insured groups, all self-funded groups and all members with individual coverage
• BCN Advantage^SM - All groups and all members with individual coverage

Spinal surgical and pain management authorizations transition from eviCore to TurningPoint

For dates of service before Jan. 1, 2021, eviCore healthcare^® manages:

• Lumbar spine surgery authorizations for Blue Cross commercial fully insured groups, Blue Cross commercial members with individual coverage and Medicare Plus Blue members
• Pain management procedures for the groups and individual members listed at the top of this message

For these services, eviCore will accept retroactive authorization requests through April 30, 2021.

For information about submitting retroactive authorization requests to eviCore, see:

• The eviCore authorization quick reference (PDF) document
• The Blue Cross eviCore-Managed Procedures page on this website
• The BCN eviCore-Managed Procedures page on this website

TurningPoint training

Professional provider, facility and portal training webinars are available through mid-January. See the "Reminder: Providers must submit authorization requests to TurningPoint for musculoskeletal procedures for most members" article in:

• The January 2021 issue of The Record
• The January-February 2021 issue of BCN Provider News, page 36

More information about TurningPoint

For more information about TurningPoint, see the following pages on this website:

• Blue Cross Musculoskeletal Services
• BCN Musculoskeletal Services

To view the lists of codes for which TurningPoint manages authorizations, see the Musculoskeletal procedure codes that require authorization by TurningPoint document.

For detailed information, see the Musculoskeletal procedure authorizations: Frequently asked questions for providers document.

Posted: January 2021
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network