Evolent Health

Trillium Community Health Plan has contracted with Evolent Health for musculoskeletal surgical procedures benefit management.

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

Prior Authorization for medical necessity and appropriate length of stay (when applicable) has been delegated to Evolent and will be required for the following surgical procedures in both inpatient and outpatient settings.

Please use the Pre-Auth Check Tool to confirm prior authorization requirements or contact Evolent for additional information.

Orthopedic Surgical Procedures

Including all associated partial, total, and revision surgeries

  • Knee arthroplasty
  • Unicompartmental/bicompartmenral knee replacement
  • Hip arthroplasty
  • Shoulder arthroplasty
  • Elbow arthrosplasty
  • Ankle arthroplasty
  • Wrist arthroplasty
  • Acromioplasty and rotator cuff repair
  • Anterior cruciate ligament repair
  • Knee arthroscopy
  • Hip resurfacinjg
  • Meniscal repair
  • 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
  • Sacroiliac joint fusion
  • Implantable pain pumps
  • Spinal cord neurostimulator
  • Spinal decompression

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.

All services previously managed by Turning Point are now managed by Evolent Health. New Century Health (NCH) and National Imaging Associates, Inc. (NIA) are affiliates of Evolent Health, collectively referred to as "Evolent." Visit Evolent for more information.