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MHS/TurningPoint Surgical Quality and Safety Management Program

Date: 05/20/19

Managed Health Services (MHS) provides health coverage for members enrolled in Hoosier Healthwise, the Healthy Indiana Plan (HIP), Hoosier Care Connect, Ambetter from MHS, and Allwell from MHS. In keeping with our commitment of promoting continuous quality improvement for services provided to our members, MHS has entered into an agreement with TurningPoint Healthcare Solutions, LLC, to implement a Musculoskeletal Surgical Quality and Safety management program. This program includes prior authorization for medical necessity and appropriate length of stay (when applicable) for both inpatient and outpatient settings. This decision is consistent with industry-wide efforts to ensure clinically appropriate quality of care and to manage the increasing utilization of these services.

Under terms of the agreement between MHS and TurningPoint Healthcare Solutions, MHS will oversee the TurningPoint Healthcare Solutions program and continue to be responsible for claims adjudication.

Based on a June 1, 2019, implementation, this correspondence serves as notice under your MHS Participating Provider Agreement of changes to the program.

TurningPoint Healthcare Solutions will manage prior authorization for medical necessity and appropriate length of stay (when applicable) for services listed below through MHS’ existing contractual relationships.  Prior authorization will be required for the following musculoskeletal surgical procedures:

TurningPoint’s Utilization Management & Precertification Contact Information:

Web Portal Intake: myturningpoint-healthcare.com

Telephonic Intake: 574-784-1005 | 855-415-7482

Facsimile Intake: 463-207-5864

Please note the following:

  • Emergency Related Procedures do not require authorization
  • It is the responsibility of the ordering physician to obtain authorization
  • Providers rendering the above services should verify that the necessary authorization has been obtained; failure to do so may result in non-payment of your claims
  • Clinical Policies are available by contacting TurningPoint at 1-574-784-1005 for access to digital copies

Training:

Informational webinars are available! Please register at: https://register.gotowebinar.com/rt/7079530369468972290.

  • Tue, May 21, 2019 11:30 AM - 12:30 PM EDT
  • Tue, May 21, 2019 4:00 PM - 5:00 PM EDT
  • Wed, May 22, 2019 11:00 AM - 12:00 PM EDT
  • Mon, May 27, 2019 4:00 PM - 5:00 PM EDT

We appreciate your support and look forward to your cooperation in assuring that MHS members receive high quality, cost-effective care for these surgical procedures.

You may access a copy of this notice as well as a detailed list of the impacted CPT codes on our website at mhsindiana.com/providers. We will also provide additional information and training opportunities as we get closer to the effective date of the program. Should you have any questions at this time, please contact MHS Provider Services at 1-877-647-4848.

Thank you for being our partner in care.



Last Updated: 05/20/2019