Musculoskeletal and Cardiac Surgical Procedures
Policies
Providers can view clinical guidelines being used by CCA at www.myturningpoint-healthcare.com. Providers will initially be asked to “Register for Access”. Upon registration, providers will be able to log into the provider portal and select the POLICIES section to view and/or download these clinical guidelines as PDF documents. Musculoskeletal and Cardiac procedures will require prior authorization for medical necessity and will be reviewed by TurningPoint Healthcare Solutions, LLC for adherence and consistency with these clinical guidelines, as well as industry standardized rules. The review will include evaluation of services for being experimental and/or investigative, as well as clinical appropriateness based upon patient demographic information.
Providers may also request copies of these clinical guidelines directly from TurningPoint by contacting their Provider Relations team at the numbers listed below, or by emailing [email protected].
Prior Authorization & Provider Portal
Providers may choose to submit requests for Prior Authorization via the web (www.myturningpoint-healthcare.com) for the following procedures. Telephonic and facsimile submissions are also supported with both the local and toll-free numbers listed above.
Musculoskeletal | Including all associated partial, total, and revision surgeries
- Knee Arthroplasty
- Uni-compartmental/Bi-compartmental Knee Replacement
- Hip Arthroplasty
- Hip Arthrodesis
- Shoulder Arthroplasty
- Elbow Arthroplasty
- Ankle Arthroplasty
- Wrist Arthroplasty
- Acromioplasty and Rotator Cuff Repair
- Anterior Cruciate Ligament Repair
- Knee Arthroscopy
- Hip Resurfacing
- Hip Osteotomy
- Meniscal Repair
- Femoroacetabular Arthroscopy
- Ankle Fusion
- Shoulder Fusion
- Wrist Fusion
- Osteochondral Defect Repair
- MPFL Reconstruction
- Spinal Fusion Surgeries
- Cervical
- Lumbar
- Thoracic
- Sacral
- Scoliosis
- Disc Replacement
- Laminectomy/Discectomy
- Kyphoplasty / Vertebroplasty
- Sacroiliac Joint Fusion
- Implantable Pain Pumps
- Spinal Cord Neurostimulator
- Spinal Decompression
- Thermal Intradiscal Procedures
Cardiac | Including all associated partial, total, and revision surgeries
- Cardiac Catheterization
- Coronary Angioplasty/Stenting
- Implantable Cardioverter Defibrillator (ICD)
- ICD Revision or Removal
- Pacemaker
- Pacemaker Revision or Removal
- Peripheral Revascularization
- Coronary Artery Bypass Grafting
- Internal Cardiac Monitoring
- Leadless Pacemaker
- Left Atrial Appendage (LAA) Occluders
- Non-Coronary Angioplasty/Stenting
- Valve Replacement
- WCD – Wearable Cardiac Defibrillator
Note: These lists are not all-inclusive and are subject to change.
Updates & Announcements
Our goal is to keep you informed with timely information about our plan and services. As changes occur and as needs arise, we issue network notifications providers via the Commonwealth Care Alliance Provider Updates webpage.
Please check these pages often to learn about updates and changes that impact your practice.
Contact Us
If you have questions, we are here to help. Please contact Provider Services at 1-866-420-9332. Our hours of operation are weekdays, excluding Thursday, 8 a.m. to 5 p.m., Eastern Time (ET) and Thursdays, 8:30 a.m. to 5 p.m., Eastern Time (ET).
