Starting this summer, some prior authorization requests for hyperbaric oxygen therapy will pend for clinical review

Starting sometime this summer, prior authorization requests for hyperbaric oxygen therapy for wounds and osteomyelitis will pend for clinical review. Currently, some of these requests are auto-approved.

This change will apply to requests submitted for BCN commercial and BCN AdvantageSM members.

After this change occurs, you'll need to do the following when you submit these requests in the e referral system:

  1. Complete the questionnaire, as usual.
  2. Attach clinical information pertinent to the request. Some examples of information to include with the request are:
    • Serial wound measurements
    • The medical and surgical treatments that were attempted but that failed to improve the member's condition

These prior authorization requests cannot be approved in the absence of clinical information supporting the request.

How to attach clinical information to the request

To learn how to attach clinical information to the request in the e-referral system, refer to the e referral User Guide (PDF). Go to the section titled "Submit Outpatient Authorization" and look for "Create new (communication)."

Additional information about the questionnaires

You can access preview questionnaires related to hyperbaric oxygen therapy that show the questions you'll have to complete on the questionnaire that opens in the e-referral system. This can guide you in preparing the answers before you submit the request.

To access the preview questionnaires, visit BCN's Authorization Requirements & Criteria page on the website. Scroll down and click to open:

Posted: March 2021
Line of business: Blue Care Network