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Health Net is partnered with TurningPoint Healthcare Solutions, LLC to provide utilization management (UM) services, including prior authorization determinations for certain inpatient and outpatient musculoskeletal procedures for fee-for-service (FFS) members.

Submit requests for prior authorization to TurningPoint for the following procedures.

Orthopedic surgical procedures (including partial, total and revision surgeries)

  • Acromioplasty and rotator cuff repair
  • Ankle arthroplasty
  • Ankle fusion
  • Anterior cruciate ligament repair
  • Elbow arthroplasty
  • Femoroacetabular arthroscopy
  • Hip arthroplasty
  • Hip arthroscopy
  • Hip resurfacing
  • Knee arthroplasty
  • Knee arthroscopy
  • Knee replacement for unicompartmental or bicompartmental
  • Osteochondral defect repair
  • Meniscal repair
  • Shoulder arthroplasty
  • Shoulder fusion
  • Wrist arthroplasty
  • Wrist fusion

Spinal surgical procedures (including partial, total and revision surgeries)

  • Disc replacement
  • Implantable pain pumps
  • Kyphoplasty or vertebroplasty
  • Laminectomy/discectomy
  • Spinal cord neurostimulator
  • Spinal decompression
  • Spinal fusion surgeries

Other operations remain unchanged:

  • In accordance with the Provider Participation Agreement (PPA), lack of prior authorization approval may result in nonpayment of claims.
  • Emergency-related procedures do not require authorization.
Last Updated: 05/23/2022