MUSCULOSKELETAL AND CARDIAC SURGICAL PROCEDURES

CareSource® covers both musculoskeletal and cardiac surgeries for our members. Orthopedic, Neuro-Spine and Cardiac providers can access the following tools to help them provide efficient and quality care.

Policies

Providers can view clinical guidelines being used by CareSource at www.myturningpoint-healthcare.com. Providers will initially be asked to “Register for Access”.  Upon registration, providers will be able to log into the provider portal and select the POLICIES section to view and/or download these clinical guidelines as PDF documents. Musculoskeletal and Cardiac procedures will require prior authorization for medical necessity and will be reviewed by TurningPoint Healthcare Solutions, LLC for adherence and consistency with these clinical guidelines, as well as industry standardized rules. The review will include evaluation of services for being experimental and/or investigative, as well as clinical appropriateness based upon patient demographic information.

Providers may also request copies of these clinical guidelines directly from TurningPoint by calling their Provider Relations team at the number listed below, or by emailing providersupport@turningpoint-healthcare.com.

 Local PhoneToll Free PhoneLocal FaxToll Free Fax
Ohio Providers(380) 203-2125(855) 927-1815(614 )441-8649(844) 472-0485

Prior Authorization & Provider Portal

Portal providers and/or their delegates should follow Ohio Department of Medicaid’s (ODM) guidelines to submit prior authorization requests and supporting documentation through the Ohio Medicaid PNM Portal.

Musculoskeletal | Including all associated partial, total, and revision surgeries

  • Knee Arthroplasty
  • Uni-compartmental/Bi-compartmental Knee Replacement
  • Hip Arthroplasty
  • Hip Arthrodesis
  • Shoulder Arthroplasty
  • Elbow Arthroplasty
  • Ankle Arthroplasty
  • Wrist Arthroplasty
  • Acromioplasty and Rotator Cuff Repair
  • Anterior Cruciate Ligament Repair
  • Knee Arthroscopy
  • Hip Resurfacing
  • Hip Osteotomy
  • Meniscal Repair
  • Femoroacetabular Arthroscopy
  • Ankle Fusion
  • Shoulder Fusion
  • Wrist Fusion
  • Osteochondral Defect Repair
  • MPFL Reconstruction
  • Spinal Fusion Surgeries
      • Cervical
      • Lumbar
      • Thoracic
      • Sacral
      • Scoliosis
  • Disc Replacement
  • Laminectomy/Discectomy
  • Kyphoplasty / Vertebroplasty
  • Sacroiliac Joint Fusion
  • Implantable Pain Pumps
  • Spinal Cord Neurostimulator
  • Spinal Decompression
  • Thermal Intradiscal Procedures

 

Cardiac | Including all associated partial, total, and revision surgeries

  • Cardiac Catheterization
  • Coronary Angioplasty/Stenting
  • Implantable Cardioverter Defibrillator
  • ICD Revision or Removal
  • Pacemaker
  • Pacemaker Revision or Removal
  • Peripheral Revascularization
  • Coronary Artery Bypass Grafting
  • Internal Cardiac Monitoring
  • Leadless Pacemaker
  • Left Atrial Appendage (LAA) Occluders
  • Non-Coronary Angioplasty/Stenting
  • Valve Replacement
  • WCD – Wearable Cardiac Defibrillator

Note: These lists are not all-inclusive and is subject to change.

Updates & Announcements

Our goal is to keep you informed with timely information about our plan and services. As changes occur and as needs arise, we issue network notifications providers via the CareSource Updates & Announcements webpage.

Please check these pages often to learn about updates and changes that impact your practice.

Contact Us

If you have questions, please contact CareSource’s Provider Services at 1-800-488-0134. Our hours of operation are Monday through Friday, 7 a.m. – 8 p.m. Eastern time (ET).