Complete the e-referral questionnaires for blepharoplasty and hyperbaric oxygen therapy for BCN members
Providers must complete questionnaires in the e-referral system for the following procedures:
- Blepharoplasty and repair of brow ptosis – beginning June 25, 2018, for any date of service
- Hyperbaric oxygen therapy – for dates of service on or after July 1, 2018
The questionnaires will open in the e-referral system when you're submitting authorization requests for BCN HMOSM (commercial) and BCN AdvantageSM members.
These procedures already require authorization. It's just the questionnaires that are new.
How the questionnaires work
If your responses to the questionnaire in the e-referral system indicate that the procedure meets criteria, the authorization request will automatically be approved. If the criteria are not met, the request will be pended for clinical review by BCN's Utilization Management staff.
For cases that are not automatically approved via e-referral after you complete the questionnaire, you must include additional clinical information. You can type the information directly into the Case Communication section in the e-referral system or you can attach it to the case. The instructions for attaching clinical information to the case are outlined in the article How to attach clinical information to your authorization request in the e-referral system, on page 44 in the November-December 2016 BCN Provider News.
Where to find medical policies and preview questionnaires
The medical policies for these procedures will guide the decisions on these authorization requests. Click to open the policies:
The medical policies for these procedures will be posted online before the end of June in the BCN section of this website, on the Authorization Requirements & Criteria page.
You'll also find preview questionnaires at that location. You can look over the preview questionnaires to see what questions you'll need to answer in the actual questionnaire that opens in the e-referral system for each service. Once you know what questions you'll need to answer, you can prepare your answers ahead of time. This can cut down on the time it takes to submit the authorization request.
Posted: May 2018
Line of business: Blue Care Network