Updated e-referral questionnaires coming for BCN and Medicare Plus Blue PPO

By Jan. 26, 2020, we expect the following updated questionnaires to start opening in the e‑referral system for certain procedures. In addition, we’ll update preview questionnaires, authorization criteria and medical policies on the ereferrals.bcbsm.com website as updated questionnaires are released.

We use our authorization criteria, medical policies and your answers to the questionnaires when making utilization management determinations on your authorization requests.

Updates to existing questionnaires

Updated questionnaires will start opening in the e-referral system for Medicare Plus Blue^SM PPO, BCN HMO and BCN Advantage^SM authorization requests (unless otherwise noted) for the following services:

• Deep brain stimulation — Opens only for BCN HMO and BCN Advantage members
• Hip replacement surgery, initial
• Hyperbaric oxygen — Opens only for BCN HMO
• Hyperbaric oxygen - Opens only for BCN Advantage members
• Knee arthroscopy, chondroplasty — Opens only for BCN HMO and BCN Advantage members
• Knee arthroscopy, diagnostic — Opens only for BCN HMO and BCN Advantage members
• Knee arthroscopy, limited synovectomy — Opens only for BCN HMO and BCN Advantage members
• Knee arthroscopy, major synovectomy — Opens only for BCN HMO and BCN Advantage members
• Knee arthroscopy, removal of loose body or foreign body — Opens only for BCN HMO and BCN Advantage members
• Knee arthroscopy, removal or stabilization of intra-articular osteochondral lesion — Opens only for BCN HMO and BCN Advantage members
• Knee arthroscopy, resection or repair of stable or unstable meniscus tear — Opens only for BCN HMO and BCN Advantage members
• Knee replacement, initial nonunicondylar
• Knee replacement, initial unicondylar
• Other lumbar spine surgery procedures — Opens only for BCN HMO and BCN Advantage members
• Shoulder replacement surgery, initial

In addition, we’ll simplify the questionnaires for some authorization requests as follows:

• We’ll replace the Spinal cord stimulator or epidural or intrathecal catheter (trial or permanent placement) questionnaire with the following three questionnaires:
• Spinal cord stimulator — For BCN HMO members
• Spinal cord stimulator — For Medicare Plus Blue and BCN Advantage members
• Intrathecal catheter — For Medicare Plus Blue, BCN HMO and BCN Advantage members
• We’ll combine the Breast reduction, adult and the Breast reduction, adolescent questionnaires for BCN HMO and BCN Advantage members into a single Breast reduction questionnaire for both adult and adolescent BCN HMO and BCN Advantage members.

Preview questionnaires

For all of these services, you can access preview questionnaires at ereferrals.bcbsm.com. 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.

To find the preview questionnaires:

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

Authorization criteria and medical policies

We also posted links to the pertinent authorization criteria and medical policies on the Authorization Requirements & Criteria pages.