21-743 Prior Authorization Changes for Cardiovascular and ENT Procedures

Date: 10/25/21

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.

Submit prior authorization requests to TurningPoint

Effective January 1, 2022, certain inpatient and outpatient cardiovascular and ear, nose and throat (ENT) procedures will require prior authorization (PA). Submit PA requests to TurningPoint Healthcare Solutions, LLC., rather than Health Net.

PA change applies to PPO, Flex Net and EPO plans. Emergency-related procedures do not require authorization.

TurningPoint will accept requests as early as December 15, 2021

Submit PA requests to TurningPoint for cardiovascular and ENT procedures listed below. If you have a PA already approved through Health Net, Health Net will honor the approved PA, subject to member eligibility.

TurningPoint Contacts

• Telephone: 855-332-5898, available Monday through Friday, 8 a.m. to 5 p.m., Pacific time
• Fax: 949-774-2254
• TurningPoint can be contracted by Email 
• or visit the TurningPoint website

Procedures requiring PA

Cardiovascular Procedures	ENT Procedures
Arterial procedures Coronary angioplasty/stenting Coronary artery bypass grafting ICD revisions or removal Implantable cardioverter defibrillator Leadless pacemaker Left atrial appendage (LAA) occluders Loop recorder Non-coronary angioplasty/stenting Pacemaker Pacemaker revision or removal Valve replacement Wearable cardiac defibrillator (WCD)	Choanal atresia Cochlear device (hearing) Fistula repair Laryngoscopy/laryngoplasty Nasal/sinus endoscopy Polyp excision Rhinoplasty/septoplasty/vestibular stenosis repair Thyroidectomy/parathyroidectomy Tonsillectomy and adenoidectomy Tympanostomy, tympanoplasty and myringotomy

Additional information

If you have questions regarding the information contained in this update, contact the applicable Health Net Provider Services Center within 60 days at:

Line of Business	Telephone Number	Provider Portal	Email Address
EnhancedCare PPO (IFP)	1-844-463-8188	provider portal	provider_services@healthnet.com
EnhancedCare PPO (SBG)	1-844-463-8188	provider portal	provider_services@healthnet.com
Health Net Employer Group HMO, POS, HSP, PPO, & EPO	1-800-641-7761	provider portal	provider_services@healthnet.com
IFP (CommunityCare HMO, PPO, PureCare HSP, PureCare One EPO)	1-888-926-2164	provider portal	provider_services@healthnet.com
Medicare (individual)	1-800-929-9224	provider portal	provider_services@healthnet.com
Medicare (employer group)	1-800-929-9224	provider portal	provider_services@healthnet.com
Medi-Cal	1-800-675-6110	provider portal	N/A
Cal Mediconnect – Los Angeles County	1-855-464-3571	N/A	provider_services@healthnet.com
Cal Mediconnect – San Diego County	1-855-464-3572	N/A	provider_services@healthnet.com