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
- 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.