TurningPoint opens peer-to-peer reviews to advanced practice providers for musculoskeletal, pain management procedures

The TurningPoint Healthcare Solutions LLC is now scheduling peer-to-peer reviews with advanced practice providers, or APPs (physician assistants and nurse practitioners). The APP peer-to-peer review process is available for participating orthopedic, pain management and spinal surgical practices that are contracted with Blue Cross Blue Shield of Michigan, Blue Care Network or both.

TurningPoint made this change to enable APPs to support physicians in the peer-to-peer review process. APPs can participate in peer-to-peer reviews related to routine prior authorization denials specific to coding, medical policy and documentation requirements for knee, ankle, shoulder, hip, elbow, wrist, spine and pain management procedures.

Reviews will be conducted by providers of the same provider type. For example, if the requesting provider is a physician assistant, the review discussion will be scheduled with a physician assistant at TurningPoint.

If you have questions about which cases are eligible for APP peer-to-peer reviews, contact the TurningPoint Provider Relations team at providersupport@turningpoint-healthcare.com.

We recently posted the following TurningPoint documents to the Musculoskeletal Services and Pain Management Services pages on ereferrals.bcbsm.com. These documents are also available through the TurningPoint Provider Portal.

• TurningPoint Peer to Peer Quick Reference Guide
• TurningPoint Advance Practice Practitioner (APP) Peer-to-Peer Process

We’re updating the Musculoskeletal procedure authorizations: Frequently asked questions for providers document to reflect this change.

Note: Provider offices will continue to have access to specialty-matched physician-to-physician peer-to-peer reviews.

For more information about TurningPoint’s Musculoskeletal Surgical Quality and Safety Management program, including information about which groups and members participate in the program, see the following pages on ereferrals.bcbsm.com:

• Blue Cross Musculoskeletal Services
• BCN Musculoskeletal Services
• BCN Pain Management Services
• Blue Cross Pain Management Services

TurningPoint Healthcare Solutions LLC is an independent company provides care review services for Blue Cross Blue Shield of Michigan and Blue Care Network.