Blue Care Network changes authorization requirements for sleep management studies

Effective July 17, 2017, 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 signs and symptoms of obstructive sleep apnea. This applies to both BCN HMO^SM (commercial) and BCN Advantage^SM members.

This is in addition to the requirement to submit evidence of the specific condition the member has that would exclude or contraindicate a home sleep study – a requirement that has been in place since Oct. 3, 2016.

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. For instructions on how to attach documentation, refer to the article "How to attach clinical information to your authorization request in the e-referral system," in the November-December 2016 BCN Provider News. These instructions are also in the e-referral User Guide, in the subsection titled "Create New (communication)."

As a reminder, home sleep studies do not require clinical review. For home sleep study requests, you must submit an authorization request to facilitate claims payment, but you are not required to complete a questionnaire for these services in the e-referral system.

Posted: May 2017
Line of business: Blue Care Network