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August 2020

New and updated questionnaires started opening in June

In June, new and updated questionnaires started opening in the e‑referral system for certain procedures. In addition, we added and updated preview questionnaires on the ereferrals.bcbsm.com website as new and updated questionnaires were released.

As background, we use your answers to the questionnaires, along with our authorization criteria and medical policies, when making utilization management determinations on your authorization requests.

New questionnaires
On June 14, 2020, we replaced the Pregnancy termination 1 — Medically necessary or elective questionnaire with the following two questionnaires for adult Blue Care Network commercial members:

  • Pregnancy termination 1 — Medically necessary. Applicable procedure codes: *01966, *59100, *59840, *59841, *59850, *59851, *59852, *59855, *59856, *59857, *59866, S0190, S0191, S0199, S2260, S2265, S2266, S2267.
  • Pregnancy termination 3 — Elective. Applicable procedure codes: *01966, *59100, *59840, *59841, *59850, *59851, *59852, *59855, *59856, *59857, *59866, S0190, S0191, S0199, S2260, S2265, S2266, S2267.

Updated questionnaire
On June 28, 2020, we updated the Vascular embolization or occlusion questionnaire for BCN commercial, BCN AdvantageSM and Medicare Plus BlueSM members.

Preview questionnaires
The preview questionnaires show the questions you’ll need to answer in the actual questionnaires that open in the e-referral system. This can help you prepare your answers ahead of time.

You can access preview questionnaires at ereferrals.bcbsm.com. To find the preview questionnaires:

  • For BCN: Click on BCN and then on Authorization Requirements & Criteria. Scroll down and look under the Authorization criteria and preview questionnaires heading.
  • For Medicare Plus Blue: Click on Blue Cross and then on Authorization Requirements & Criteria. In the Medicare Plus Blue PPO members section, look under the Authorization criteria and preview questionnaires heading.

Authorization criteria and medical policies
The pertinent authorization criteria and medical policies are available on the Authorization Requirements & Criteria pages of ereferrals.bcbsm.com.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2019 American Medical Association. All rights reserved.