Updated preview questionnaire is available for excisional breast biopsy
An updated excisional breast biopsy preview questionnaire is now available on the Clinical Review & Criteria Charts page on this website. Look under the "Medical necessity criteria / benefit review requirements" heading.
When you submit a request for clinical review for this procedure through BCN's e-referral system, you'll be prompted to complete a questionnaire on the appropriateness of the service. If the criteria are met, the request is automatically approved. If the criteria are not met, the request will require additional clinical review. For urgent requests, contact BCN Care Management by phone at 1-800-392-2512.
Minor style and grammatical changes were made to the questionnaire within the e-referral system and those are reflected in the preview questionnaire. No changes were made to the criteria for this service.
As a reminder, clinical review is required for excisional breast biopsy for members with Blue Care Network HMOSM (commercial) products - including self-funded groups - and for members with BCN AdvantageSM products.
Look for additional information about this in the May-June 2016 issue of BCN Provider News, which will be available in late April.
Posted: February 2016
Line of business: Blue Care Network