MedicaidPrior AuthHigh impact
20-470 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
Starting August 11, 2020, prior authorization for musculoskeletal surgical procedures (orthopedic and spinal) must be submitted to TurningPoint Healthcare Solutions instead of Health Net for specific member types. This affects Medi-Cal FFS members 21+, Direct Network HMO, POS, and PureCare HSP members in designated California counties.
Action Required
Immediately: Billing team must update prior authorization workflow to submit all musculoskeletal surgical procedure requests to TurningPoint Healthcare Solutions (phone: 1-855-332-5898, fax: 949-774-2254, email: centenecaum@turningpoint-healthcare.com) instead of Health Net for affected member types. Update staff training and encounter forms to reflect new authorization vendor. Register for TurningPoint webinar training. Failure to obtain proper prior authorization may result in claim denials.