Radiology Management Program
Blue Care Network introduced a new authorization program in 2007 for high-tech radiology procedures. The program initially focused on MRIs and CT scans of the lower spine; additional procedures were added in three phases in 2008 and 2009.
New authorization requirements for myocardial perfusion imaging procedure codes became effective Oct. 1, 2008. Authorization requirements for MRI of the brain, CT of the brain, CT of the pelvis and CT of the abdomen became effective Jan. 1, 2009. Authorization requirements for CT and MRI of the lumbar spine were revised Jan. 1, 2009. The Jan. 1, 2009, effective date also included a new authorization requirement for MRI and CT of the lumbar spine procedures for BCN Advantage members. Additional codes went into effect April 1, 2009. Please see the Blue Care Network Referral and Clinical Review Program for a list of the procedure codes.
Primary care physicians and specialists must submit clinical information via e-referral by responding Yes or No to questions about the medical need for the procedure. All of the questions require a response, or an error message will appear and the case will pend. Once the provider submits the completed questionnaire, the system will automatically approve the request, providing the member meets criteria. No additional actions are required.
For cases that are not automatically approved via e-referral, providers can include additional clinical information in e-referral by using the iEXCHANGE® Comment section to document pertinent information that will help facilitate a determination by BCN Care Management staff.
If you do not have Internet access or have difficulty completing the questionnaire, call BCN Care Management at 1-800-392-2512.
The authorization requirements do not apply to procedures conducted in urgent care centers, emergency rooms and during inpatient hospital stays. This information applies to all BCN products except BlueCaid and BCN 65.