The Record

We’ve added and updated questionnaires in e-referral system

On Aug. 27, 2023, Blue Cross Blue Shield of Michigan and Blue Care Network added and updated questionnaires in the e-referral system. We also updated the corresponding authorization criteria and 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 prior authorization requests.

New questionnaire

We added the following questionnaire to the e-referral system:

Questionnaire

Opens for

Details

Balloon ostial dilation

Medicare Plus Blue℠
BCN commercial
BCN Advantage℠

Opens for procedure codes *31295, *31296, *31297 and *31298
Note: For dates of service on or before Aug. 27, 2023, the Sinusotomy questionnaire opens for these procedure codes.

Updated questionnaires

We updated the following questionnaires:

Questionnaire

Opens for

Updates

Deep brain stimulation

Medicare Plus Blue
BCN commercial
BCN Advantage

Updated two questions

Endovascular intervention, peripheral artery

Medicare Plus Blue
BCN Advantage

No longer opens for procedure codes *0238T, *34101, *34111, *34151, *34201, *34203, *37184 and *37222
Note: Effective Sept. 1, 2023, this questionnaire no longer opens for BCN commercial members because these procedures will be managed by Carelon Medical Benefits Management.

Responsive neurostimulator/deep brain stimulation trigger

BCN commercial
BCN Advantage

Updated the question

Responsive neurostimulation for the treatment of refractory focal epilepsy

BCN commercial
BCN Advantage

Updated the title of the questionnaire to align with the title of the updated medical policy.

Septoplasty

Medicare Plus Blue
BCN commercial
BCN Advantage

Updated two questions

Sinusotomy

Medicare Plus Blue
BCN commercial
BCN Advantage

“No longer open for procedure codes *31295, *31296, *31297 and *31298”
Removed questions related to balloon ostial dilation
Updated several questions

Thyroidectomy, total

Medicare Plus Blue
BCN commercial
BCN Advantage

Updated five questions

Preview questionnaires

Preview questionnaires show the questions you’ll need to answer in the e-referral system so you can prepare your answers ahead of time.

To find the preview questionnaires, go to ereferrals.bcbsm.com and:

For Medicare Plus Blue: Click on Blue Cross and then click on Authorization Requirements & Criteria. Scroll down and look under the Authorization criteria and preview questionnaires — Medicare Plus Blue heading.

For BCN: Click on BCN and then click on Authorization Requirements & Criteria. Scroll down and look under the Authorization criteria and preview questionnaires heading.

Authorization criteria and medical policies

The Authorization Requirements & Criteria pages explain how to access the pertinent authorization criteria and medical policies.

Carelon Medical Benefits Management is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to manage authorizations for select services. For more information, go to our ereferrals.bcbsm.com website.

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 2022 American Medical Association. All rights reserved.