Avoid blocked inpatient authorization e-referral submissions by using the correct criteria

For a successful inpatient authorization submission in e-referral, please note the following

• When submitting a non-elective medical admission in e-referral, providers should enter the following in the Inpatient Authorization drop-down menus:
  • Type of Care: Direct, Elective, Emergency, Transfer or Urgent
  • Place of Service: Inpatient Hospital
  • Primary Procedure Code: *99221-99239
• If a lumbar spinal fusion surgery has already been authorized by eviCore healthcare^® for Blue Cross' PPO and Medicare Plus Blue^SM PPO members, and the provider believes the member should be admitted as inpatient, the facility should request an Inpatient Authorization in e-referral using the following drop-down menus:
  • Type of Care: Direct
  • Place of Service: Inpatient Hospital
  • Primary Procedure Code: *99222

Submitting incorrect information for these lumbar spinal fusion procedures will result in an error message indicating that you are unable to submit the request and ask you to modify the Type of Care or CPT code.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2019 American Medical Association. All rights reserved.

Posted: June 2020
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network