Clarifying biofeedback and neurofeedback authorization requirements for BCN members

When submitting authorization requests for biofeedback and neurofeedback for BCN HMO^SM (commercial) and BCN Advantage^SM members, there are things you have to do differently for each. Here's what you need to know.

Biofeedback is covered, when authorized, for specific medical diagnoses and not for behavioral health diagnoses.

• When you submit your initial request to authorize biofeedback, you must attach all the required clinical documentation to the case in the e-referral system.
• BCN's Utilization Management staff, not the Behavioral Health staff, make the determination on the request.

In the future, you'll also need to complete a questionnaire for biofeedback in the e-referral system. Look for more information about that in upcoming web-DENIS messages and articles in BCN Provider News.

Neurofeedback is covered, when authorized, for specific behavioral health diagnoses only.

• Neurofeedback requires an independent evaluation (psychological or neuropsychological testing) confirming that the member has a diagnosis of attention deficit hyperactivity disorder or attention deficit disorder. This must be completed by someone other than the neurofeedback provider.
• When you submit your initial request to authorize neurofeedback, you must attach the report from the independent evaluation to the case in the e-referral system, along with any additional clinical documentation required.
• BCN's Behavioral Health staff, not the Utilization Management staff, make the determination on the request.
• When you submit requests to authorize additional neurofeedback visits, you must complete the questionnaire that opens in the e-referral system.

Instructions for attaching a document from the member's medical record are outlined in the article How to attach clinical information to your authorization request in the e-referral system, in the November-December 2016 BCN Provider News, on page 44. These instructions are also in:

• The e-referral User Guide. Look in the "Submit Outpatient Authorization" section, under "Create New (communication)."
• The Behavioral Health e-referral User Guide. Look in the section titled "Submitting a Neurofeedback Authorization," under "Create New (communication)."

The Care Management and Behavioral Health chapters of the BCN Provider Manual will be updated with these clarifications.

Posted: February 2019
Line of business: Blue Care Network