Additional updated authorization criteria and e-referral questionnaires

We're making updates to the authorization criteria and questionnaires in the e-referral system, for the following services:

• Cholecystectomy (laparoscopic) for adults
• Endoscopy, upper gastrointestinal, for gastroesophageal reflux disease
• Hyperbaric oxygen therapy
• Varicose vein treatment

For these services, you'll see the updated questionnaires in the e-referral system starting Dec. 16, 2018.

We use these criteria and questionnaires when making utilization management determinations for the following members:

• BCN HMO^SM (commercial)
• BCN Advantage^SM

The updated authorization criteria and preview questionnaires are available at ereferrals.bcbsm.com. To find them, click BCN, then click Authorization Requirements & Criteria. Next, look in the "Authorization criteria and preview questionnaires" section.

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: December 2018
Line of business: Blue Care Network