Determining whether to submit prior authorization requests for musculoskeletal procedures to TurningPoint for Blue Cross commercial members
Providers are responsible for identifying the need for authorization through web-DENIS, Benefit Explainer or Provider Inquiry and for contacting vendors and obtaining authorization for services, as needed.
To determine whether you need to submit a prior authorization request to TurningPoint Healthcare Solutions LLC for a musculoskeletal procedure for a Blue Cross commercial member:
Important! When authorization isn't required for the musculoskeletal procedure, you must still obtain prior authorization from Blue Cross for the inpatient admission. Submit the prior authorization request for the inpatient admission for procedure code *99222 through the e-referral system as outlined in the "Submit an inpatient authorization" section of the e-referral User Guide (PDF). In the request, attach the clinical information or insert notes that specify the procedure that will be performed. Do not submit musculoskeletal procedure codes.
You can find this same information in the question titled "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.
As a reminder, TurningPoint manages authorizations for orthopedic, pain management and spinal procedures for the following:
*CPT codes, descriptions and two-digit modifiers only are copyright 2020 American Medical Association. All rights reserved.
Posted: April 2021
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network