Submit BCN enteral nutrition authorization requests using the e-referral system
You must submit authorization requests for enteral nutrition for BCN members using the e-referral system. We no longer accept these requests when you submit them by fax.
This applies to BCN HMOSM (commercial) and BCN AdvantageSM members, for procedure codes B4034, B4035, B4036, B4081, B4082, B4083, B4087, B4088, B4102, B4103, B4104, B4105, B4149, B4150, B4152, B4153, B4154, B4155, B4157, B4158, B4159, B4160, B4161, B4162, B9002, B9998, S9341, S9342 and S9343.
Note: You must still submit authorization requests for total parenteral nutrition by fax.
Here's some additional information you need to know:
- Enteral nutrition requests are approved for a maximum of 90 calendar days. For additional services after 90 days, you must submit a new authorization request through the e-referral system.
- You'll need to complete the questionnaire that opens in the e-referral system. Refer to the enteral nutrition preview questionnaire, so you can prepare your answers ahead of time.
- Refer to the e-referral User Guide for instructions on how to submit an outpatient authorization request.
- You'll find additional resources on how to use the e-referral system on this website, on the Training Tools page.
- You'll find a link to the enteral nutrition medical policy on BCN's Authorization Requirements & Criteria page on this website.
- We use our medical policy and your answers to the questionnaire when making utilization management determinations for the authorization requests you submit.
- We've revised the form you previously used to submit these requests by fax. You should now use that form only for total parenteral nutrition requests.
- We'll update the Care Management chapter of the BCN Provider Manual in the near future to reflect these changes.
Posted: August 2019
Line of business: Blue Care Network