Start submitting cardiac & MSK authorization requests to TurningPoint today

Our new authorization programs with TurningPoint has launched for cardiac and MSK services taking place on and after Sept. 1, 2024.

Be sure to check if you have surgeries already scheduled that will now require authorization. Review the impacted code lists to see which services and procedures are now managed by TurningPoint on our members’ behalf. Bolded codes are those that don’t currently require authorization but will for dates of service on / after September 1.

For impacted services scheduled on and after Sept. 1, 2024, submit your authorization requests to TurningPoint. Below is an FAQ to support your success:

How do you submit an authorization in TurningPoint?

Our provider portal, prism, will automatically redirect you to TurningPoint to complete authorization requests when appropriate – no separate login needed. Find step-by-step instructions in our TurningPoint provider training guide.

What if you’ve already submitted a request through GuidingCare?

If you’ve already submitted an authorization request to Priority Health through GuidingCare, there’s no need to resubmit through TurningPoint. Your existing authorization request will be honored.

What if you’re requesting a service taking place before September 1?

For services taking place before September 1, you’ll still be directed to TurningPoint’s portal to submit the request. TurningPoint’s team will immediately forward your request to Priority Health for review. TurningPoint will also send you a fax to let you know your case has been forwarded.

Once the faxed request is received by Priority Health, our team will load it into GuidingCare. You’ll be able to check on your request there once this process happens.

Where can you find clinical guidelines?

Authorization requests for cardiac and MSK services taking place on and after September 1 will be reviewed by TurningPoint using their clinical guidelines. You have two ways to access these guidelines, via your prism account:

  1. Under the Authorizations tab, click Authorization Criteria Lookup. Then click the link for TurningPoint criteria.
  2. When submitting a request for a procedure managed by TurningPoint, you’ll be routed to TurningPoint’s provider portal automatically. There, you can find clinical guidelines under the Procedures tab.

Where can you learn more?

Visit our TurningPoint resources webpage, which includes FAQs, impacted procedure codes, turnaround times, peer-to-peer appeals information and more.

To access this landing page, log into your prism account. Under the Authorizations menu, click Request an Authorization. On the resulting page, click Auth request help page then Get TurningPoint resources.

Are provider trainings available?

Yes! There are still two opportunities to join our utilization management team and TurningPoint staff to learn about the authorization programs, as well as how to navigate and successfully request authorizations through TurningPoint.

Registration is open for the following dates, which each session starting at 12 p.m. ET:

  • August 28
  • September 4