New Prior Authorization Program for Musculoskeletal Surgical Procedures

Vibra Health Plan (VHP) is pleased to announce the launch of a Surgical Quality and Safety Management Program in conjunction with TurningPoint Healthcare Solutions, LLC (TurningPoint). This collaboration is designed to promote patient safety through the practice of high quality and cost effective care for VHP members undergoing Musculoskeletal Surgical Procedures.

Effective April 1, 2022

Prior authorization services for hip, knee and shoulder and spinal surgical procedures in both inpatient and outpatient settings will be delegated to TurningPoint. The specific codes that are in scope for this release are included as an attachment.

The existing VHP Authorization Requirements list of codes requiring prior authorization is 9000 available on the provider page under Documents, Resources, and Bulletins.

TurningPoint provides various methods to request prior authorization from their Utilization management and Precertification area including:

An important component of the Surgical Quality and Safety Management program will include specialized "Peer to Peer" engagement opportunities. During these opportunities, TurningPoint physicians will engage providers of the same specialty to review authorization requests that require additional clinical discussion to validate the clinical appropriateness of the procedure specific to the patient’s needs and current condition.

If you have additional questions at this time, please contact your assigned Provider Engagement Consultant.

TurningPoint Healthcare Solutions is an independent company providing prior authorization services for musculoskeletal inpatient and outpatient surgical procedures.

Updated October 1, 2021