CommercialPrior AuthHigh impact
21-743 Prior Authorization Changes for Cardiovascular and ENT Procedures
Health Net·CA · Cardiology, ENT (Ear, Nose & Throat), Cardiothoracic Surgery·Prior Authorization
Effective date
Jan 1, 2022
We identified it
Jun 20, 2026
Summary
Starting January 1, 2022, cardiovascular and ENT procedures for PPO, Flex Net, and EPO plans require prior authorization through TurningPoint Healthcare Solutions instead of Health Net. Emergency procedures are exempt from this requirement.
Action Required
Immediately: Billing team must update prior authorization workflows to submit requests to TurningPoint Healthcare Solutions (855-332-5898, fax 949-774-2254) for all cardiovascular and ENT procedures listed in policy for PPO, Flex Net, and EPO plans. Update encounter forms and EMR alerts to remind providers. Train staff on new submission process. Claims will be denied without proper prior authorization through TurningPoint.