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TurningPoint - Surgical Quality and Safety Management Program

Buckeye Health Plan (BHP) is pleased to announce the launch of a new and innovative Surgical Quality and Safety Management Program, effective August 15, 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 BHP members undergoing Cardiac Surgical Procedures.

Program Highlights Include:

  • Administrative Tools to support an efficient, user friendly authorization process for procedures requiring precertification, in addition to recommended medical necessity determinations for procedures which do not require precertification. Easy and efficient post-procedural documentation submission which will be shared
    with BHP to facilitate timely claims payment.
  • Specialized “Peer to Peer” Engagement where a TurningPoint physician (from the same specialty) engages the provider regarding authorization requests that require additional clinical discussion to validate the clinical appropriateness of the procedure specific to the patient’s needs and current condition.
  • Clinical Support Tools to assist in the tracking and monitoring of patient outcomes and education around patient risks and preventive measures to better coordinate care for the member and reduce infection rates and complications due to patient comorbidities.
  • Reporting, and Analytics that gives Physicians and practice administrators greater visibility and transparency into their performance compared to the practice as a whole, as well as the rest of the market.
  • FDA Recall Tracking and Monitoring to facilitate timely and consistent notification to the Physician, patient, and to BHP when a member has received or needs a revision surgery due to a Class I or II FDA device recall.

This correspondence serves as notice under your Participating Buckeye Community Health Plan Provider Agreement of these program changes, effective August 15, 2019. TurningPoint will begin accepting prior authorization requests for these procedures beginning August 1, 2019 for dates of service August 15, 2019 or later.

The program will include the followingBuckeye Health Plan Membership: Medicaid, Ambetter, AllWell and MyCareOhio (Opt-In) Members.

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 the following surgical procedures in both inpatient and outpatient settings:

  • Cardiac
    • AICD/ICD
    • Leadless Pacemaker
    • Pacemaker
    • Revision or replacement of ICD or Pacemaker
    • CABG (non-emergent only)
    • Coronary Angioplasty & Stents
    • Non-Coronary Angioplasty & Stents

TurningPoint's Utilization Management & Precertification Contact Information:

Key Provisions:

  • Emergency Related Procedures do not require authorization
  • It is the responsibility of the ordering physician to obtain authorization
  • Providers rendering the above services should verify that the necessary authorization has been obtained. Failure to do so may result in non-payment of your claims.
  • Prior Authorization Scope Coding Handout (PDF)

We appreciate your support and look forward to your cooperation in assuring that Buckeye Health Plan members receive high quality cost-effective care for these surgical procedures.

Should you have any questions at this time, please contact Buckeye Health Plan Provider Services at (866) 296-8731.