User Guide Supplement: Completing referrals for high ... - e-Referral

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User Guide Supplement: Completing referrals for high ... - e-Referral

User Guide Supplement:Completing referrals forhigh-tech radiology procedurese-referral on the iEXCHANGE ® systemereferrals.bcbsm.com February 2009


Initiating a high-tech radiology referralUse New Other Requestto request approval fornew services.Providers can expedite a request by submitting a prior authorization requestthrough e-referral and completing the appropriate questionnaire. If all questionsare answered, e-referral will determine the status of the case based on theprovider’s response. If the case pends and BCN cannot authorize it, BCN willcontact the provider for additional clinical information.1 e-referral user guide


Initiating a high-tech radiology referral (cont.)The physicians in your groupwill appear in this list. Alwaysselect the physician that BCNhas listed as the patient’sPCP or the referral will pend.Both the member contract andmember suffix are required. Theremust be a hyphen between thecontract number and the two-digitmember suffix. If you do not knowthe member suffix, enter the contractnumber and click on Member search.Select the treatment settingfor the services you areauthorizing.Supplement2


Initiating a high-tech radiology referral (cont.)A procedure code isrequired. You can enter acode or ...This list can be customized tosuit your needs. Select a codefrom the drop-down list or ...1... useProceduresearch to finda code.2 3You can enter Servicing providerinformation three different ways. Youcan select a provider from the dropdownlist, enter a valid NPI, or useProvider search.**Enter the BCN provider NPI numberof the facility performing services.If you don’t know the number, youcan do a search by clicking on theProvider search button. The dropdownlist can be customized by yourprovider representative.**When performing a provider search, multiple results for the same physician/facility may bereturned. Always be sure that the physician/facility you select is contracted with BCN.3 e-referral user guide


Initiating a high-tech radiology referral (cont.)Enter the numberof services you areauthorizing.The scheduled date of aprocedure sometimes changesafter submitting your request.Enter a date appropriate forthe services being requested.You can entercomments to BCNor to the servicingprovider in thisfield.Supplement4


Completing a questionnaire (cont.)The questionsrequire a Yes orNo response.Supplement6


Completing a questionnaire (cont.)You must answer allquestions. Do not leave anyblank.7 e-referral user guide


Completing a questionnaire (cont.)This is the first in alist of references thatare not part of thequestionnaire.The absence of a Yes orNo selection indicates thatthese lines are not partof the questionnaire. Youshould not enter informationin these spaces.You must click theSubmit questionnairebutton to complete theprocess.Supplement8


Completing a questionnaire (cont.)This warning indicates thatquestion #10 in the CT of theBrain questionnaire was notanswered.The case pended due toincomplete information.CLICK HERE to updatethe questionnaire.9 e-referral user guide


Completing a questionnaire (cont.)This is the unansweredquestion that causedthe case to pend.Supplement10


Completing a questionnaire (cont.)Once you have provided the missing information, you mustclick the Submit questionnaire button again to update yourrequest and complete the process.11 e-referral user guide


Completing a questionnaire (cont.)The status is updatedand the procedure isauthorized if criteriaare met.Supplement12


Submitting your requestClick the Submit buttonto enter the referral inthe system. If you donot click on Submit,your referral will not betransmitted to BCN.13 e-referral user guide


You can recognize the various tabs and their labels thathelp you navigate through e-referral by the following colors:Teal green – Starting pointPurple – ReferralBright green – InpatientViolet – SearchGold – OtherBlue Care Networke-referral contact informationCare Management:800-392-2512Behavioral HealthCall the Mental Health/SubstanceAbuse number on the back of themember’s ID card.Provider Affairs EastFlint: 800-527-1906Saginaw: 800-859-2898Provider Affairs MidLansing: 877-258-0168Provider Affairs Southeast866-299-4667Provider Affairs WestGrand Rapids: 800-968-2583 Ext. 6158Portage: 800-968-2583 Ext. 6158Traverse City: 800-968-2583 Ext. 6158For technical helpWeb Help Desk: 877-258-3932ereferrals.bcbsm.com091165BCNM

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