The Record

Questionnaire changes in e-referral

On Jan. 28, 2024, we added, updated and deleted questionnaires in the e-referral system. We also added, updated and deleted the corresponding preview questionnaires from the Authorization criteria and preview questionnaires document 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 questionnaires

The following questionnaires replaced the Vascular embolization or occlusion of hepatic tumors (TACE/RFA) questionnaire:

Questionnaire

Opens for

Updates

TACE and radioembolization of liver tumors trigger

Medicare Plus Blue℠
BCN commercial
BCN Advantage℠

Opens for procedure code *37243

Transcatheter arterial chemoembolization of hepatic tumors (TACE)

Opens for procedure codes *37242, *37243 and *75894

Radioembolization for tumors of the liver

Opens for procedure code *37243

Updated questionnaire

We updated the following questionnaire in the e-referral system:

Questionnaire

Opens for

Updates

Orthognathic surgery

Blue Care Network commercial
BCN Advantage

Updated a question

Deleted questionnaires

We deleted the following questionnaires from the e-referral system:

Questionnaire

Details

Computed tomography to detect coronary artery calcification

This questionnaire was deleted. It no longer opens for BCN commercial members.
Procedure code S8092 no longer requires prior authorization.

Vascular embolization or occlusion of hepatic tumors (TACE/RFA)

This questionnaire was deleted and replaced with other questionnaires, as discussed in the “New questionnaires” section earlier in this article.

Preview questionnaires

You can access this document by going to ereferrals.bcbsm.com and doing the following:

For Medicare Plus Blue: Click on Blue Cross and then click on Prior Authorization. Scroll to the “Authorization information for Medicare Plus Blue members” section and click the Authorization criteria and preview questionnaires link.

For BCN: Click on BCN and then click on Prior Authorization and Plan Notification. Scroll to the “Authorization criteria and preview questionnaires for select services” section and then click the Authorization criteria and preview questionnaires link.

Authorization criteria and medical policies

The Authorization criteria and preview questionnaires document explains how to access the pertinent authorization criteria and medical policies.

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 2023 American Medical Association. All rights reserved.