At TurningPoint Healthcare Solutions we are committed to ensuring that all patients receive high-quality, evidence-based care. Our Clinical Policies and Guidelines are developed by a team of industry-leading physicians in collaboration with many nationally recognized societies. We consider our Clinical Policies and Guidelines to be the foundation of the improved quality, efficiency, and improved outcomes we deliver.
If you are a Provider and would like to view our Clinical Policies and Guidelines, these are available to you through our Provider Portal at https://www.myturningpoint-healthcare.com/#!/.
For Medicare members, CMS coverage criteria (National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), etc.) are evaluated and applied first. TurningPoint’s internal coverage criteria are only used when there is no applicable CMS criteria, in compliance with CMS-4201-F. If you would like access to Medicare Coverage Criteria, please click the link below to be re-directed to CMS MCD Search.
Medicare Coverage Criteria: https://www.cms.gov/medicare-coverage-database/search.aspx
For all other health plan members, prospective health plan enrollees, or a member of the general public, if you would like access to TurningPoint’s internal coverage criteria, please complete the form below so that we can ensure that we provide you with the Clinical Policy or Guideline responsive to your inquiry, as our Clinical Policies often vary by Health Plan, Benefit Plan, State and Line of Business. All requests are routed through TurningPoint’s Provider Relations ticketing system for verification, and a response will be provided upon verification.
A TurningPoint representative will respond to your request within the timeframes below:
1. Requests received by 4pm EST will be returned the same day by 6pm EST
2. Requests received after 4pm EST will be returned the following business day by 6pm EST
3. Requests made after 4pm on a Friday will be returned the following Monday by 6pm EST. The same timeframe applies to requests made over the weekend (Saturday and Sunday).
