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California Health & Wellness is no longer a Medi-Cal plan starting January 1, 2024. Regardless of the county you live in, your Medi-Cal service and benefits will not be impacted by the health plan changes since you will be assigned to a new health plan. The county you live in determines your new health plan. Learn more
California Health & Wellness is no longer a Medi-Cal plan starting January 1, 2024. Regardless of the county you live in, your Medi-Cal service and benefits will not be impacted by the health plan changes since you will be assigned to a new health plan. The county you live in determines your new health plan. Learn more

20-471 Changes to Prior Authorization Process and Requirements for Musculoskeletal Surgical Procedures

Date: 06/08/20

TurningPoint must approve prior authorization requests for these surgical procedures 

On August 11, 2020, certain musculoskeletal inpatient and outpatient surgical procedures will require prior authorization from TurningPoint Healthcare Solutions, LLC, rather than California Health & Wellness Plan (CHWP). 

This prior authorization change applies to CHWP members ages 21 and over enrolled with a managed care plan.

TurningPoint will accept requests as early as July 28, 2020

Refer to page 2 for musculoskeletal surgical procedures that require prior authorization from TurningPoint. If you have a prior authorization already approved through CHWP, CHWP will honor the approved prior authorization, subject to member eligibility.

Contact TurningPoint to submit prior authorization requests 

Contact TurningPoint and not CHWP to request approval for musculoskeletal surgical procedures that require prior authorization. 

TurningPoint Contacts

Telephone1-855-332-5898, available Monday through Friday, 8 a.m. to 5 p.m., Pacific time
Fax(949) 774-2254
Emailcentenecaum@turningpoint-healthcare.com
WebsiteTurningPoint Website
TrainingRegister for a webinar

Other operations remain unchanged. As a reminder:

  • In accordance with your contract with CHWP, lack of prior authorization approval may result in nonpayment of claims. 
  • Emergency-related procedures do not require authorization.   

Musculoskeletal surgical procedures that require prior authorization

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

Orthopedic surgical procedures (including partial, total and revision surgeries1) 

  • 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 surgeries1) 

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

TurningPoint contacts 

  • Register for a webinar.
  • Submit an authorization on their website or by fax to (949) 774-2254.
  • For questions call 1-855-332-5898, available Monday through Friday, 8 a.m. to 5 p.m., Pacific time. 

Contact CHWP with questions

Call 1-877-658-0305.

 

1 Effective August 11, 2020, musculoskeletal surgical procedures require prior authorization from TurningPoint Healthcare Solutions, LLC.