Inpatient peer-to-peer policy update goes into effect September 4
Effective Sept. 4, 2024, and in alignment with industry standards, inpatient peer-to-peer reviews (P2P) will only consider the clinical information submitted with the initial authorization request.
June 29, 2025
New radiation oncology authorizations program to launch this fall
We’re partnering with EviCore on a new authorization program for outpatient radiation oncology procedures. This new program is slated to launch Sept. 15, 2024.
June 29, 2025
New authorization requirement for non-urgent inpatient hospital transfers
When a member is receiving non-urgent inpatient care, we’ll soon require prior authorization before their care can be transferred to a different facility. This change will go into effect Mar. 10, 2025, and won’t impact urgent / emergent hospital transfers.
June 25, 2025
Reminder callbacks not possible for inpatient P2P cases
We’re sharing a reminder that call backs to our medical director team aren’t available for missed peer-to-peer (P2P) calls for inpatient cases.
June 25, 2025
Authorization requests for 73700 and 73200 now auto approve
Authorization requests for diagnostic imaging procedures 73700 and 73200 now auto approve.
June 25, 2025
2025 InterQual transition coming June 2
Beginning June 2, 2025, we’ll use 2025 InterQual® criteria to make medical necessity determinations on prior authorization requests.
June 25, 2025
Authorization appeal update effective June 2
Effective June 2, 2025, we won’t review post-claim appeals for medical necessity when a denied authorization is on file for the following authorization types, for all lines of business: outpatient, home health, DME, elective inpatient, behavioral health.
June 25, 2025
Reminder EviCore radiation oncology authorizations and resources
As a reminder, our new radiation oncology authorizations program with EviCore launched on Sept. 15, 2024. To support you in getting your patients, our members, the care they need when they need it, EviCore offers a variety of provider resources and trainings.
June 25, 2025
New DME auth requirement for Q0508
Effective July 15, 2025, we’ll require prior authorization for HCPCS code Q0508 – used for miscellaneous supplies or accessories used with an implanted ventricular assist device (VAD) –when exceeding our standard DME thresholds.
June 25, 2025
TurningPoint portal downtime on May 24
TurningPoint's provider portal will be temporarily offline for scheduled maintenance between 7-9 p.m. ET on May 24.
June 25, 2025
Updated TurningPoint provider training guide available
We’ve updated the TurningPoint Provider Training Guide to include: additional information requests (all plans); Intent to deny calls (Medicare); reconsideration requests (commercial, Medicaid).
June 25, 2025
New authorization requirement for renal denervation
Effective Apr. 6, 2025, we’ll require prior authorization for the following procedures for Medicare cases: 0338T and 0339T.
June 23, 2025