ALERT: e-referral system is displaying updated BCN sleep study questionnaire earlier than expected
The e-referral system is displaying an updated BCN sleep study questionnaire earlier than the intended effective date of Oct. 3, for providers who request authorization for outpatient facility and clinic-based sleep management studies for adult members 18 years of age and older.
Here is what's happening: The updated questionnaire instructs providers to attach evidence from the member's medical record that confirms the specific condition the member has that excludes or contraindicates a home sleep study. This is requested for dates of service prior to Oct. 3, 2016, even though it is required only for dates of service on or after Oct. 3, 2016.
The result is that all cases pend, even for dates of service prior to Oct. 3.
Here's what to do: For requests to authorize these procedures for dates of service prior to Oct. 3, do the following:
- Complete the questionnaire in the e-referral system. This includes commenting on:
- Symptoms of sleepiness
- Daytime sleepiness determined by an assessment tool (Epworth Sleepiness Scale or the Stanford Sleepiness Scale)
- Level of alertness different times of the day
- Diabetes
- Presence of other health conditions
- Neck circumference
- For repeat sleep studies, submit the results of the initial sleep study. Attach these results to the authorization request in the e-referral system.
For dates of service prior to Oct. 3, BCN's Care Management staff will review the answers on the questionnaire without requiring evidence from the member's medical record showing that a home sleep study is excluded or contraindicated.
We apologize for any confusion caused by the updated questionnaire appearing for dates of service prior to Oct. 3.
Posted: September 2016
Line of business: Blue Care Network