December 2018
E-referral system now includes updated authorization criteria and questionnaires
We’ve made updates to the authorization criteria and questionnaires in the e-referral system for the following services:
- Hip replacement surgery procedure, initial
- Hyperbaric oxygen therapy,** outpatient
- Knee replacement surgery, nonunicondylar, initial
- Knee replacement surgery, unicondylar, initial
- Lumbar spine surgery** for adults
- Transcatheter arterial chemoembolization of hepatic tumors, or TACE
- Endometrial ablation**
- Cervical spine surgery with artificial disc replacement**
- Shoulder joint replacement surgery
- Deep brain stimulation
The updated questionnaires are in the e-referral system. We use these criteria and questionnaires when making utilization management determinations for the following members:
- BCN HMOSM
- BCN AdvantageSM
- Blue Cross Medicare Plus BlueSM PPO
**Only applies to BCN HMO and BCN Advantage members.
The updated authorization criteria and preview questionnaires are available at ereferrals.bcbsm.com. Here’s where to find them:
- For BCN documents — From ereferrals.bcbsm.com, click on BCN, then click Authorization Requirements & Criteria. Next, look in the Authorization criteria and preview questionnaires section.
- For Medicare Plus Blue documents — From ereferrals.bcbsm.com, click on Blue Cross, then click Authorization Requirements & Criteria. Next, look in the For Blue Cross Medicare Plus Blue PPO members section.
You can look over the preview questionnaires to see what questions you’ll need to answer in the e-referral system for each service, and then prepare your answers ahead of time. This can cut down on the time it takes to submit the authorization request. |