MedicaidCoverageHigh impact
[Ohio] TurningPoint Annual Policies March 2026
CareSource·OH · Cardiology, Cardiothoracic Surgery, Orthopedics +2 more·Provider Bulletin
Effective date
May 1, 2026
We identified it
May 9, 2026
Summary
CareSource/TurningPoint has updated 80 cardiac and musculoskeletal service policies (version .25) effective May 1, 2026 for both Ohio Medicaid and Ohio FIDE plans. This is an annual policy refresh covering procedures from implantable devices to joint replacements and spinal surgery. Billing teams must obtain and review the updated policy details at www.myturningpoint-healthcare.com to ensure compliance with any revised prior authorization requirements, coverage criteria, or documentation standards.
Action Required
By April 15, 2026: Billing team and clinical staff must access www.myturningpoint-healthcare.com and review all 80 updated policies (.25 versions) for cardiac (CA-1001.25 through CA-1012.25 plus GN-1001.25) and orthopedic/musculoskeletal (OR-1001.25 through OR-1050.25) procedures. For each policy, identify: (1) prior authorization requirements, (2) medical necessity criteria, (3) coverage limitations, and (4) any documentation changes. Update billing system rules, encounter templates, and provider communication to reflect new requirements. By May 1, 2026: Apply all policy changes to claims processing. Failure to comply with updated prior authorization and coverage requirements will result in claim denials for affected cardiac and orthopedic procedures.