[Georgia] CareSource Cardiac and Musculoskeletal Surgical Quality and Safety Management Program in Partnership with TurningPoint

By May 1, 2024: Billing team and providers must implement the following: (1) Verify prior authorization requirements for ALL cardiac and musculoskeletal surgical procedures (both inpatient and outpatient) using the TurningPoint Procedure Code Lookup Tool before scheduling or service delivery; (2) Update billing system workflows to REQUIRE prior authorization submission to TurningPoint (Web: myturningpoint-healthcare.com, Phone: 678-528-2056 or 855-941-5310, Fax: 404-201-6624) for affected procedures; (3) Train all front desk, authorization, and billing staff on the new TurningPoint portal registration and submission process; (4) Update encounter forms and pre-admission checklists to remind providers to obtain authorization; (5) Implement a verification process where facility staff confirm authorization completion prior to patient admission. NOTE: Emergency procedures are exempt from prior authorization. Consequence: Claims for cardiac and musculoskeletal surgeries submitted without prior authorization will be DENIED by CareSource and will NOT be paid.