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Surgical Quality and Safety Management Program

Date: 08/29/19

Effective October 1, 2019, Arizona Complete Health will launch a new and innovative Surgical Quality and Safety Management Program. The program is designed to work collaboratively with physicians to promote patient safety through the practice of high quality and cost-effective care for Arizona Complete Health members undergoing Musculoskeletal Surgical procedures.

As a part of this program, Arizona Complete Health will begin working with TurningPoint Healthcare Solutions, LLC to process prior authorization requests for medical necessity and appropriate length of stay (when applicable) for Musculoskeletal Surgical procedures.

Program highlights include:

  • Administrative Tools to support an efficient, user-friendly authorization process for procedures requiring prior authorization, in addition to recommended medical necessity determinations for procedures that do not require prior authorization. These tools allow for easy and efficient post-procedural documentation submissions, which will be shared with Arizona Complete Health 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 tracking and monitoring patient outcomes, education around patient risks, preventive measures to better coordinate care for the patient while reducing infection rates and complications due to patient comorbidities.
  • Provider Performance Incentives for providers who comply with program requirements to practice high-quality, cost-effective care.
  • Reporting and Analytics that gives providers 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 provider, patient, and Arizona Complete Health when a patient has received or needs a revision surgery due to a Class I or II FDA device recall.

Physicians will be able to begin submitting requests to TurningPoint for prior authorization beginning on September 15, 2019, for dates of service on or after October 1, 2019. Prior authorization will be required for the following Musculoskeletal surgical procedures in both inpatient and outpatient settings:

Orthopedic Surgical Procedures

(Including all associated partial, total and revision surgeries)

(Including all associated partial, total and revision surgeries)
  • Knee Arthroplasty
  • Unicompartmental/Bicompartmental Knee Replacement
  • Hip Arthroplasty
  • Shoulder Arthroplasty
  • Elbow Arthroplasty
  • Ankle Arthroplasty
  • Wrist Arthroplasty
  • Acromioplasty and Rotator Cuff Repair
  • Anterior Cruciate Ligament Repair
  • Knee Arthroscopy
  • Hip Arthroscopy
  • Femoroacetabular Arthroscopy
  • Ankle Fusion
  • Shoulder Fusion
  • Wrist Fusion
  • Osteochondral Defect Repair

Spinal Surgical Procedures

(Including all associated partial, total and revision surgeries)
  • Spinal Fusion Surgeries
  • Cervical
  • Lumbar
  • Thoracic
  • Sacral
  • Scoliosis
  • Disc Replacement
  • Laminectomy/Discectomy
  • Kyphoplasty/Vertebroplasty
  • Implantable Pain Pumps
  • Spinal Cord Neurostimulator
  • Spinal Decompression

Please note:

  • 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 claims.
  • Authorization requirements for facility and radiology may also be applicable.

Providers may access a detailed list of impacted CPT codes on TurningPoint’s Web Portal or by visiting https://www.azcompletehealth.com/providers/preauth-check.html

For questions regarding this notification, utilization management or prior authorization, and to submit prior authorization requests, please contact TurningPoint at:

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