Updated e-referral questionnaire to open June 28 for BCN and Medicare Plus Blue^SM PPO

Starting June 28, 2020, an updated Vascular embolization or occlusion (TACE/RFA) questionnaire will open in the e-referral system. We'll also update the related preview questionnaire on this website.

The preview questionnaire shows the questions you'll need to answer in the actual questionnaire that opens in the e-referral system. This will help you prepare your answers ahead of time.

We use our authorization criteria and medical policies and your answers to the questionnaires when making utilization management determinations on your authorization requests.

To find the preview questionnaire on this website:

• For BCN: Click BCN and then click Authorization Requirements & Criteria. Scroll down and look under the "Authorization criteria and preview questionnaires" heading.
• For Medicare Plus Blue: Click Blue Cross and then click Authorization Requirements & Criteria. In the "Medicare Plus Blue PPO members" section, look under the "Authorization criteria and preview questionnaires - Medicare Plus Blue PPO" heading.

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