September, October questionnaire updates in e-referral system

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

In September and October:

• We updated six questionnaires in the e-referral system.
• We removed one questionnaire from the e-referral system.

As questionnaires are updated or removed, we’ll update or remove the corresponding preview questionnaires on ereferrals.bcbsm.com.

Updated questionnaires

• Endoscopy, upper gastrointestinal, for gastroesophageal reflux disease: On Sept. 27, 2020, we updated the list of procedure codes for which providers must complete this questionnaire for BCN commercial and BCN Advantage℠ members.
  
  Since Sept. 27, providers must complete this questionnaire for these procedure codes: *43191, *43192, *43193, *43195, *43196, *43197, *43198, *43200, *43201, *43202, *43214, *43231, *43233, *43235, *43237, *43238, *43239, *43241, *43242, *43248, *43249, *43250, *43253 and *43259.
  
  Providers will no longer need to complete the questionnaire for these procedure codes: *43180 and *43254.

• Sacral nerve neuromodulation/stimulation: On Oct. 11, we updated this questionnaire for Medicare Plus Blue℠ PPO, BCN commercial and BCN Advantage members.
• Breast implant management: On Oct. 25, we updated this questionnaire for BCN commercial and BCN Advantage members.
• Breast reconstruction: On Oct. 25, we updated this questionnaire for BCN commercial and BCN Advantage members.
• Breast reduction: On Oct. 25, we updated this questionnaire for BCN commercial and BCN Advantage members.
• Orthognathic surgery: On Oct. 25, we updated this questionnaire for BCN commercial and BCN Advantage members.

Removed questionnaire
On Sept. 27, we removed the Lumbar spine surgery, minimally invasive questionnaire for BCN Advantage members. The e-referral system now automatically approves requests for code G0276.

Preview questionnaires
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.

You can  find the preview questionnaires as follows:

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