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TurningPoint Healthcare Solutions Authorization Program Beginning October 1, 2019
8/6/2019 • Posted by Provider Relations

Fidelis Care is pleased to announce the launch of a new and innovative Surgical Quality and Safety Management Program, effective October 1, 2019*.  The program is designed to work collaboratively with physicians to promote patient safety through the practice of high quality and cost-effective care for Fidelis Care members undergoing Musculoskeletal Surgical Procedures.  Prior Authorization for medical necessity and appropriate length of stay (when applicable) has been delegated to TurningPoint Healthcare Solutions, LLC. and will be required for orthopedic surgical procedures and spinal surgical procedures in both inpatient and outpatient settings.  

The program will include the following Fidelis Care health insurance products: 

  • Medicaid Managed Care (NYM)  
  • HealthierLife (HARP)
  • Child Health Plus (CHP)    
  • Metal-level Products (qualified health plan)
  • Medicare Advantage (MA)    
  • Essential Plan (EP)
  • Dual Advantage (DUAL)    
  • Medicaid Advantage Plus (MAP)

**TurningPoint’s Utilization Management & Precertification Contact Information:

**TurningPoint will begin accepting requests for prior authorization beginning September 16, 2019, for dates of service October 1, 2019, and beyond.

Further details regarding this new prior authorization program can be found by viewing the resource links below.
TurningPoint Healthcare Solutions Provider Notice
TurningPoint Healthcare Solutions CPT Codes

Additional information and training opportunities/dates for providers will be shared as they become available.

*Note:  This new prior authorization program is pending New York State approval. 

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Important Information on Coverage Decisions

Each day, Fidelis Care's Utilization Management (UM) Department makes decisions on numerous health insurance claims. These decisions are based only on appropriateness of care and the existence of coverage. 

Fidelis Care does not reward practitioners or other individuals for issuing denials of coverage, and does not offer financial incentives to UM staff that would encourage decisions that result in underutilization of services. 

Fidelis Care is committed to ensuring that members have the care and services they need. 

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