Starting in June, we’ll use clinical information to validate providers’ answers to some questionnaires in the e-referral system

Beginning in June 2021, we’ll pend some authorization requests that would usually be auto‑approved based on your responses to questionnaires in the e‑referral system.

This applies to authorization requests submitted for BCN commercial, Medicare Plus Blue^SM and BCN Advantage^SM members.

When we pend a request, you’ll get this message in the e‑referral system:

“Case requires validation. Medical records required. Please attach clinical information from the patient’s medical record applicable to this request in the Case Communication field.”

For instructions on how to attach clinical information to the authorization request in the e‑referral system, refer to the e‑referral User Guide. Look in the section titled “Create New (communication).”

We’ll review and verify that the clinical information you provide supports your responses to the questionnaire and make a determination on the request.

If we don’t receive the clinical information or the information you send doesn’t support your answers in the questionnaire, we won’t be able to approve the request.

As a reminder, on the preview questionnaires that we publish on our ereferrals.bcbsm.com website, we state that we’ll retrospectively monitor compliance with this authorization requirement. You can access the preview questionnaires:

• On the Blue Cross Authorization Requirements & Criteria page
• On the BCN Authorization Requirements & Criteria page