BCBSNE Provider Procedures
Blue Cross and Blue Shield of Nebraska’s (BCBSNE) procedures provide important information for physician and health care professionals, facilities, psychiatric, and dental providers. Type key words into the search bar below to find the information you need pertaining to:
- Billing and reimbursement
- Medicare Advantage
- Dental
- General
Current Updates
December 2024
- GP-PI-001 Pharmacy- How to Request Preauthorizations
- GP-F-002 Federal Employee Health Benefits Program
- MA-X-002 ID Card
- MA-X-003 Eligibility and Coverage
- MA-X-004 NaviNet®
- MA-X-005 Billing Members
- MA-X-009 Primary Care Physicians
- MA-X-010 Hospice Services
- MA-X-011 Access to Care
- MA-X-013 Claim Filing
- MA-X-018 Clinical Review of Inpatient Services
- MA-X-019 Application of Medical Necessity Criteria
- MA-X-020 Inter-Rater Reliability
- MA-X-044 Other Considerations in the Notice of Medicare Non-Coverage (NOMNC) Process
- MA-X-062 Immunization
- MA-X-070 Questions, Additional Information and Contacts
- MA-X-072 Medicare Advantage (MA) Critical Access Hospital Cost Settlement for In-Network Providers
- MA-X-075 MA Part B Utilization Management Review with NCD or LCD Policy Number M.17
- MA-X-079 Medicare Advantage (MA) Split-Year Claim Submission
- MA-X-093 Medicare Advantage (MA) Auto Approval for SNF Admissions
- MA-X-094 Qualified Medicare Beneficiary (QMB) Program
November 2024
- GP-X-062 Accreditation
- MA-X-077 MA Prior Authorization and Precertification Requirements
October 2024
- GP-I-002 Readmission Quality Program
- MA-X-076 MA Part B Utilization Management Review with NCD or LCD Policy Number M.17
- MA-X-073 MA Part B Step Therapy for Outpatient Medications Policy Number M.18
- MA-X-074 MA Part B Drug Prior Authorization List
- MA-X-077 MA Prior Authorization and Precertification Requirements
InterQual® Criteria
Access InterQual Criteria by signing in or creating an account. InterQual Criteria is evidence-based clinical decision support criteria developed by Change Healthcare, LLC and/or one of its subsidiaries. Change Healthcare, LLC, is an independent company providing services for BCBSNE, an independent licensee of the Blue Cross Blue Shield Association.
Medical Record Standards
Updated 05/17/21
Includes record management, documentation tips, general medical record documentation, required documentation for specific services and sending medical records to BCBSNE.
Medical Policies
A uniform set of medical policies, including criteria for medical necessity of certain DME/HME products, is established by the Blue Cross and Blue Shield of Nebraska Medical Policy Committee.
View Medical Policies on MedPolicy Blue »
Medical policy and pre-certification guidelines are specific to each member's Blue Plan.
Find a member's Blue Plan by Prefix »
Definitions, Terms and Abbreviations
Includes definitions of terms for healthcare providers to reference.
Definitions, Terms and Abbreviations
(Updated 07/05/23)
Behavioral Health Policies
Refer to InterQual® Criteria to view medical necessity criteria for psychiatric and substance abuse services; including acute inpatient admissions, residential treatment center admissions, outpatient visits. InterQual® Criteria is evidence-based clinical decision support criteria developed by Change Healthcare, LLC and/or one of its subsidiaries.
For more than 90 visits per calendar year, please Submit a Behavioral Health Outpatient Form.
For psych/neuropsych testing in excess of four hours per calendar year, please Request a Psych/Neuropsych Evaluation.
Behavioral health medical policies are also available in MedPolicy Blue. Visit MedPolicy Blue »
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