Additional updated authorization criteria and e-referral questionnaires in effect
We made updates to the authorization criteria and questionnaires in the e-referral system, for the following services:
- Endovascular intervention, peripheral artery
- Ethmoidectomy, endoscopic
- Sacral nerve stimulation
The updated questionnaires began opening in the e-referral system starting Aug. 26, 2018.
We use these criteria and questionnaires when making utilization management determinations for the following members:
- BCN HMOSM (commercial)
- BCN AdvantageSM
- Blue Cross Medicare Plus BlueSM PPO
The updated authorization criteria and preview questionnaires are available on this website. Here's where to find them:
- For BCN documents — Click BCN, then click Authorization Requirements & Criteria. Next, look in the "Authorization criteria and preview questionnaires" section.
- For Medicare Plus Blue documents — Click Blue Cross, then click Authorization Requirements & Criteria. Next, look in the "For Blue Cross Medicare Plus Blue PPO members" section.
You can look over the preview questionnaires to see what questions you'll need to answer in the actual questionnaire that opens in the e-referral system for each service. Once you know what questions you'll need to answer, you can prepare your answers ahead of time. This can cut down on the time it takes to submit the authorization request.
Posted: August 2018
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network