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May 2024

Questionnaire changes in e-referral system

On March 31, 2024, we added one questionnaire and updated other questionnaires in the e-referral system.

We’ve updated the Authorization criteria and preview questionnaires document on the ereferrals.bcbsm.com website to reflect these changes.

As a reminder, we use our authorization criteria, our medical policies and your answers to the questionnaires in the e-referral system when making utilization management determinations on your prior authorization requests.

New questionnaire

We’ve added the following questionnaire to the e-referral system.

Questionnaire

Opens for

Updates

Endoscopic bypass E&I trigger

  • Blue Care Network commercial
  • BCN Advantage℠

Opens for procedure codes *43644 and *43645

Updated questionnaires

We’ve updated the following questionnaires in the e-referral system.

Questionnaire

Opens for

Updates

Cosmetic or reconstructive surgery

  • BCN commercial
  • No longer opens for BCN Advantage or Medicare Plus Blue℠

Dental general anesthesia

  • BCN commercial
  • No longer opens for BCN Advantage
  • Updated two questions
  • Removed one question

Dental general anesthesia or dental services trigger

  • BCN commercial
  • No longer opens for BCN Advantage

Dental services

  • BCN commercial
  • No longer opens for BCN Advantage

Excess skin removal

  • BCN commercial
  • No longer opens for BCN Advantage

Orthognathic surgery

  • BCN commercial
  • No longer opens for BCN Advantage

Responsive neurostimulator / deep brain stimulation trigger

  • BCN commercial
  • BCN Advantage
  • Updated a question

Surgical treatment for male gynecomastia

  • BCN commercial
  • BCN Advantage
  • Updated a question in the BCN commercial questionnaire

Preview questionnaires

Preview questionnaires show the questions you’ll need to answer in the e-referral system so you can prepare your answers ahead of time.

To find the preview questionnaires, see the document titled Authorization criteria and preview questionnaires.

You can access this document by going to ereferrals.bcbsm.com and doing the following:

  • For Medicare Plus Blue: Click on Blue Cross and then click on Prior Authorization. Scroll down and look under the “Authorization information for Medicare Plus Blue members” heading.
  • For BCN: Click on BCN and then click on Prior Authorization & Plan Notification. Scroll down and look under the “Authorization criteria and preview questionnaires for select services” heading.

Authorization criteria and medical policies

The Authorization criteria and preview questionnaires document explains how to access the pertinent authorization criteria and medical policies.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2023 American Medical Association. All rights reserved.