MedicaidPrior AuthHigh impact
20-472 Changes to Prior Authorization Process and Requirements for Musculoskeletal Surgical Procedures
Health Net·CA · Orthopedics, Neurosurgery, Pain Management·Prior Authorization
Effective date
Aug 11, 2020
We identified it
Jun 20, 2026
Summary
Effective August 11, 2020, prior authorization requests for musculoskeletal surgical procedures (orthopedic and spinal surgeries) for Medi-Cal FFS members ages 21+ in Fresno, Kings and Madera counties must be submitted to TurningPoint Healthcare Solutions instead of Health Net/CalViva Health. This affects all orthopedic and spinal surgical procedures including joint replacements, arthroscopy, spinal fusions, and pain management procedures.
Action Required
Immediately: Billing and authorization teams must redirect all prior authorization requests for musculoskeletal surgical procedures for Medi-Cal FFS members ages 21+ in Fresno, Kings and Madera counties to TurningPoint Healthcare Solutions. Contact TurningPoint at 1-855-332-5898, fax (949) 774-2254, or email centenecaum@turningpoint-healthcare.com instead of Health Net. Update authorization workflows and staff training. Failure to obtain proper prior authorization may result in nonpayment of claims.