New cardiology authorizations program to launch this summer
We’re partnering with TurningPoint on a new authorization program for cardiac surgical procedures, designed to facilitate provider-to-provider collaboration on each member’s care plan. This new program is slated to launch this summer.
The goal of this partnership is to optimize health outcomes for cardiac patients and work more closely with you, our provider partners, on evidence-based, value-driven care.
About TurningPoint
TurningPoint is an independent specialty condition management company with 120+ clinical experts focused on sub-specialties in high-complexity, high-cost categories – including cardiology. Their process is aligned with our clinical approach by reviewing requested care and using evidence-based guidelines to develop care plans in collaboration with network physicians.
How does TurningPoint work?
You'll initiate the authorization request process in prism, as you do now. prism’s Request an Authorization page will be updated to include redirection to TurningPoint, in addition to GuidingCare and eviCore.
When a cardiac procedure requires authorization through TurningPoint, prism will automatically redirect you to TurningPoint’s online authorization portal.
TurningPoint cardiac physicians will then review each authorization request, initiating a discussion with the requesting physician if needed to shape the member’s care plan. The goal with each request is to get our members the right care at the right time at the right cost and site of care. TurningPoint’s process results in a lower denial rate and a reduction in appeals.
What procedures will require authorization through TurningPoint?
Beginning this summer, the following service categories will require authorization through TurningPoint, for both inpatient and outpatient procedures, including all associated partial, total and revision surgeries:
- Coronary Artery Bypass Grafting (CABG)
- Coronary Angioplasty / Stenting
- Implantable Cardioverter Defibrillator
- Leadless Pacemaker
- Pacemaker
- Peripheral Revascularization
- Revision or Replacement of Implanted Cardiac Devices
- Non-Coronary Angioplasty / Stenting
- Valve Replacement
- Wearable Cardiac Defibrillator
- Percutaneous Left Atrial Appendage Occluder
- Internal Cardiac Monitoring
What’s next?
In the coming weeks, you’ll receive additional information to ensure your providers have ample opportunity to be trained on using TurningPoint’s online authorization portal and to ask any questions they may have. Additional information will include:
- FAQs
- Peer-to-peer and appeals information
- Training webinars
- Provider instruction manual
- And more