TurningPoint Healthcare Solutions

Sunshine Health has contracted with TurningPoint Healthcare Solutions, LLC for Ear, Nose and Throat Surgical Procedures, effective October 15, 2021, for Ambetter (Marketplace) and Allwell (Medicare).

Effective December 1, 2021, the program will apply to Sunshine Health’s Medicaid and Children’s Medical Services (CMS) Health Plan members.

The program is designed to work collaboratively with physicians to promote patient safety through the practice of high quality and cost-effective care for Sunshine Health members.

Sunshine Health oversees the new Ear, Nose and Throat Program and is responsible for claims adjudication. 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.

Ear, Nose and Throat (ENT)

Tonsillectomy &/or Adenoidectomy
Sinus Surgery
Rhinoplasty, Septoplasty
Laryngoscopy/Laryngoplasty
Cochlear Device (hearing)
Tympanostomy/Tympanoplasty
Thyroidectomy/Parathyroidectomy
Balloon Dilation Esophagoscopy

For information on Prior Authorizations, please visit our Pre-Auth Check Tool page to see if a pre-authorization is needed. It's quick and easy. If an authorization is needed, you can access our login to submit online.