Turning Point Prior Authorization

Arkansas Health & Wellness is pleased to announce the launch of an innovative Surgical Quality and Safety Management Program effective 1/1/2020. This program works with physicians to promote patient safety through the practice of high quality and cost-effective care for members undergoing Musculoskeletal Surgical Procedures.

Program Highlights Include:

  • Administrative Tools that provide an efficient user-friendly authorization process for procedures requiring precertification and give insight to recommended medical necessity determinations for procedures that do not require precertification. This includes easy and efficient post- procedural documentation submission that will be shared with Arkansas Health & Wellness to facilitate timely claims payment.
  • Specialized “Peer to Peer” Engagement where a TurningPoint physician (from the same specialty) works with the provider on authorization requests that require additional clinical discussion in order to validate the clinical appropriateness of the procedure based on the patient’s needs and current condition.
  • Clinical Support Tools that assist in tracking and monitoring patient outcomes and provide education on patient risks and preventive measures to better coordinate care for the member. These support tools help reduce infection rates and complications due to patient comorbidities.
  • Provider Performance Incentives for providers who comply with program requirements to practice high quality, cost effective care.
  • Reporting and Analytics that give physicians and practice administrators greater visibility and transparency into their performance compared to the practice as a whole, as well as the rest of the market.
  • FDA Recall Tracking and Monitoring to facilitate timely and consistent notification to the physician, patient, and to Arkansas Health & Wellness when a member has received or needs a revision surgery due to a Class I or II FDA device recall.

This communication serves as notice under your Participating Arkansas Health & Wellness Provider Agreement of these program changes, effective 1/1/2020. Physicians will be able to begin submitting requests to TurningPoint for Prior Authorization beginning on 12/16/2019 for dates of service on or after 1/1/2020. While it is the responsibility of the rendering physician to obtain prior authorization, facility providers are encouraged to contact TurningPoint to verify the prior authorization has been completed for Arkansas Health & Wellness members prior to admission.

The program will include the following Arkansas Health & Wellness Membership: Ambetter and Wellcare by Allwell Members.

Prior Authorization for medical necessity and appropriate length of stay (when applicable) has been delegated to TurningPoint Healthcare Solutions, LLC. and will be required for the following surgical procedures in both inpatient and outpatient settings:

TurningPoint’s Utilization Management & Precertification Contact Information:

KEY PROVISIONS:

  • Emergency Related Procedures do not require authorization.
  • It is the responsibility of the ordering physician to obtain authorization.
  • Providers rendering the above services should verify that the necessary authorization has been obtained. Failure to do so may result in non-payment of your claims.

You may access a copy of this notice and a detailed list of impacted CPT codes on our website. We will also provide additional information and training opportunities, as we get closer to the effective date of the program. Should you have any questions at this time, please contact the Arkansas Health & Wellness Health Plans Provider Services Line at (800) 294-3557.