What’s new about authorization criteria and e-referral questionnaires for certain services

For certain services for Blue Cross Blue Shield of Michigan Medicare Plus Blue^SM members, the authorization criteria and the questionnaires in the e-referral system have been updated. Click here to see which services have revised authorization criteria and questionnaires.

How the questionnaires work

If your responses to the questionnaire in the e-referral system indicate that the procedure meets the criteria, the authorization request will automatically be approved. If the criteria aren’t met, the request will be pended for clinical review by Blue Cross Utilization Management staff.

For cases that aren’t automatically approved via e-referral after you complete the questionnaire, you must include additional clinical information. You can type the information directly into the Case Communication section in the e-referral system or you can attach it to the case. The instructions for attaching clinical information to the case are outlined in the e-referral User Guide. Search for “Create New (communication)” and find the instructions for attaching a document to the case.

Where to find authorization criteria and preview questionnaires

The updated authorization criteria are available at ereferrals.bcbsm.com. Click on Blue Cross and then on Authorization Requirements & Criteria. Look under the For Blue Cross Medicare Plus Blue PPO members heading.

You’ll also find the new and updated preview questionnaires at that location. You can look over the preview questionnaires to see what questions you’ll need to answer in the actual questionnaire that opens in the e-referral system for each service. Once you know what questions you’ll need to answer, you can prepare your answers ahead of time. This can cut down on the time it takes to submit the authorization request.