Updated authorization criteria and e-referral questionnaire for ethmoidectomy

We're making updates to the ethmoidectomy authorization criteria and questionnaire in the e-referral system.

You'll see the updated questionnaire in the e-referral system starting May 26, 2019.

We use the criteria and questionnaire when making utilization management determinations for the following members:

• BCN HMO^SM
• BCN Advantage^SM
• Medicare Plus Blue^SM PPO

The updated authorization criteria and preview questionnaire 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 Medicare Plus Blue PPO members" section.

You can look over the preview questionnaire to see what questions you'll need to answer in the actual questionnaire that opens in the e-referral system for this 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: May 2019
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network