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 HMO^SM
• BCN Advantage^SM
• Blue Cross Medicare Plus Blue^SM 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.