Starting May 9, new and updated questionnaires in the e-referral system
We use our authorization criteria, our medical policies and your answers to the questionnaires in the e-referral system when making utilization management determinations on your authorization requests.
On May 9, 2021, we'll add and update questionnaires in the e-referral system. We'll also add and update the corresponding preview questionnaires on this website.
New questionnaires
We're adding the following questionnaires:
- Experimental and investigational services - This questionnaire will open for adult BCN commercial and BCN AdvantageSM members for all procedure codes that are configured as experimental and investigational in our systems.
- Medical formula for inborn errors of metabolism - This questionnaire will open for adult and pediatric BCN commercial and BCN Advantage members for procedure codes B4157 and B4162 for certain diagnosis codes.
- Not otherwise classified codes — This questionnaire will open for adult and pediatric BCN commercial and BCN Advantage members for all procedure codes that are configured as not otherwise classified in our systems.
Updated questionnaires
We're updating the following questionnaires:
- Endoscopy, upper gastrointestinal, for GERD - For adult BCN commercial and BCN Advantage members. This questionnaire will no longer open for procedure code *43201. It will continue to open for all other procedure codes and all diagnoses listed in the Endoscopy, upper gastrointestinal, for GERD preview questionnaire (PDF).
- Prostatic urethral lift - For adult BCN commercial and BCN Advantage members. This questionnaire will open for procedure code C9769. (It already opens for procedure codes *52441 and *52442.)
Preview questionnaires
You can access preview questionnaires on this website. They show the questions you'll need to answer in the actual questionnaires that open in the e-referral system. This can help you prepare your answers ahead of time.
To find the preview questionnaires, click BCN and then click Authorization Requirements & Criteria. Scroll down and look under the "Authorization criteria and preview questionnaires" heading.
Authorization criteria and medical policies
The pertinent authorization criteria and medical policies are also available on the Authorization Requirements & Criteria page.
*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2020 American Medical Association. All rights reserved.
Posted: May 2021
Line of business: Blue Care Network