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:

1. Log in to bcbsm.com as a provider.
2. Click the Musculoskeletal Service Authorization through TurningPoint link in the Provider Secured Services welcome page.
3. Click the words Blue Cross' PPO in the blue bar at the top of the box on the right.
4. Enter the member's contract number and click Enter.
5. Click the Authorization And Referrals link for the appropriate member.
6. You'll see one of the following:
   • If prior authorization IS required for the member: You'll see a message stating that you need to contact TurningPoint. Submit an authorization request to TurningPoint by entering the NPI, pressing Enter and following the prompts. You can also submit requests by fax or phone; see the Musculoskeletal procedure authorizations: Frequently asked questions for providers (PDF) document for details.
   • If prior authorization ISN'T required for the member: You'll receive a message stating that prior authorization isn't required.

   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:

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

*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