We’ve made some questionnaire changes in e-referral system

In July and August, we added, updated and removed questionnaires in the e-referral system. We also added, updated and removed the corresponding preview questionnaires on the ereferrals.bcbsm.com website.

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

New questionnaire

We added a Medicare implantable ambulatory event monitors questionnaire for pediatric and adult Medicare Plus Blue℠ and BCN Advantage℠ members. This questionnaire opens for procedure code *33285.

Updated questionnaires

We updated the following questionnaires:

• Endovenous ablation for treatment of varicose veins — For adult Medicare Plus Blue, BCN commercial and BCN Advantage members. We updated some of the questions in this questionnaire.
• Implantable ambulatory event monitors — This questionnaire opens only for pediatric and adult BCN commercial members. (The Medicare implantable ambulatory event monitors questionnaire opens for Medicare Plus Blue and BCN Advantage members, as noted above.)
• Sacral nerve neuromodulation/stimulation — For adult Medicare Plus Blue, BCN commercial and BCN Advantage members. We updated the possible answers for some of the questions. 
• Sleep studies, outpatient facility or clinic-based setting — For adult BCN commercial and BCN Advantage members. This questionnaire no longer opens for procedure codes *95782 and *95783. It continues to open for other procedure codes.
• Vascular embolization or occlusion (TACE/RFA) — For adult Medicare Plus Blue, BCN commercial and BCN Advantage members. We updated some of the questions in this questionnaire.

Removed questionnaires

We removed the questionnaires below, which currently open for procedure code *64568. These questionnaires will no longer open for any members, as this procedure code no longer requires prior authorization.

• Hypoglossal nerve stimulator — condition trigger
• Hypoglossal nerve stimulator — adolescent or young adult
• Hypoglossal nerve stimulator — adolescents with Down syndrome
• Hypoglossal nerve stimulator — adults

Accessing preview questionnaires, authorization criteria and medical policies

You can access the preview questionnaires, authorization criteria and medical policies on the following pages of the ereferrals.bcbsm.com website:

• Blue Cross Authorization Requirements & Criteria
• BCN Authorization Requirements & Criteria