UPDATED: Changes in BCN's sleep study requirements

The following changes in Blue Care Network's sleep study requirements are occurring:

Home sleep studies. Effective immediately, home sleep studies do not require clinical review, but an authorization is still needed in the e-referral system so that claims can be paid. This means that there is no longer a need to complete a questionnaire in the e-referral system for home sleep studies.

As a reminder, only providers who have signed a specific sleep testing agreement may provide home sleep studies to BCN members. Hospitals billing for services related to home sleep studies must also execute a specific sleep testing agreement and bill in accordance with BCN requirements.

Sleep studies in outpatient and clinic-based settings. Effective Oct. 3, 2016, all requests to authorize outpatient facility and clinic-based sleep management studies for adult members 18 years of age and older will require the submission of evidence from the member's medical record. This evidence must confirm the specific condition the member has that would exclude or contraindicate a home sleep study. This applies to BCN HMO^SM (commercial) and BCN Advantage^SM members.

Providers can facilitate the authorization request by completing the sleep study questionnaire for outpatient facilities or clinic-based settings in the e-referral system. Any documentation from the patient's medical record that is required can be attached to the request within the e-referral system, through the Case Communication field.

Additional information. Look for more information on this in the July-August 2016 issue of BCN Provider News, which will be available online at the end of June.

Posted: June 2016
Line of business: Blue Care Network