Policies and Procedures
The contents of the Policy and Procedures site are contractually binding for compliance based on your provider agreement with Blue Cross and Blue Shield of Nebraska (BCBSNE). All providers are required to follow all applicable BCBSNE policies and procedures, as well as those applicable to the covered person.
Contracting providers agree to share appropriate information with their employees, agents, and representatives to ensure full adherence to these requirements.
BCBSNE’s policies and procedures offer essential guidance for physicians, health care professionals, facilities, psychiatric providers, and dental providers. Use the search bar below to find information related to:
- Billing and reimbursement
- Medicare Advantage
- Dental
- General policies
Current Updates
March 2026
February 2026
January 2026
- GP-X-104 Professional and Respectful Communication Standards
- GP‑X‑074 Complaint Investigation and Process
- GP-X-073 Reconsideration Requests
- DP-X-003 Oral Appliances for Sleep Apnea Treatment
- MA-X-077 MA Prior Authorization and Precertification Requirements
- MA-X-073 MA Part B Drug Prior Authorization List
- GP-PI-001 Pharmacy – How to Request Preauthorizations
- MA-X-051 MA Contracted Provider Appeals
- GP-X-014 Preauthorization and Precertification
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 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 »