Reimagine Preauthorization

We are dedicated to continuously refining our processes and strengthening our partnerships with the provider community.

In November 2024, we engaged with providers from across Nebraska, ranging from large metropolitan institutions to small rural practices, to gather feedback on our current preauthorization process. While we received commendations for our strengths, we also identified several areas for improvement.

In line with our commitment to reimagining preauthorizations and the feedback we received from providers, we are excited to introduce Reimagine Preauthorization, a resource designed to keep you informed about the latest updates and enhancements.

Check back frequently to ensure you are up to date on our processes.

Preauthorization procedure updates

Welcome to our preauthorization procedure updates section, where you can easily find codes that have been updated or removed from preauthorization review requirements. By consolidating this information in one location, we aim to enhance transparency, reduce administrative burden and improve efficiency. Our goal is to support your office with clear, streamlined information, making your work simpler and more effective.

Jan. 1, 2025

Medicare Advantage auto approval for the first seven days in SNF admissions.

Jan. 10, 2025

Preauthorizations are no longer required for CPAP (Continuous Positive Airway Pressure) Devices (E0561, E0562, E0601).

Feb. 15, 2025

Preauthorizations are no longer required for Lung Cancer Screenings (71271).

March 15, 2025

Preauthorizations are no longer required for Myocardial Perfusion Imaging (78451, 78452, 78453, 78454).

Insights and innovations in provider collaboration

Explore the latest articles highlighting our ongoing efforts to enhance operational efficiency, strengthen provider partnerships across Nebraska and support continuous learning. Stay informed with updates designed to keep you connected and empowered.

Enhancing efficiency

We are implementing InterQual^® criteria for the codes listed below. When the criteria are met, these codes will no longer require manual review, allowing for automatic adjudication of claims. The list of applicable codes will be updated periodically as new codes are added.

These updates reflect our ongoing commitment to streamlining processes, reducing administrative burden and improving timely access to essential health care services for our members. We remain focused on managing authorization timelines effectively and are continuously challenging ourselves to do the right thing for the right reasons.

By removing unnecessary preauthorization requirements based on diagnostic codes, we are enabling our clinical teams to focus their expertise on reviewing more complex cases. When criteria are met, approvals will be automated, ensuring greater efficiency and better use of clinical resources.

You can access InterQual Criteria by signing in or creating an account.

Med policy	Effective date
Cardiac Event Monitors (I.155)	July 1, 2024
Treatment of Sacroiliac Joint (III.189)	July 1, 2024
Intensity Modulated Radiation Therapy (IV.72)	Feb. 1, 2025
Bariatric Surgery (III.212)	Feb. 1, 2025
Cardiac Catheter Ablation for Tx for Afib (I.211)	March 1, 2025
Transcranial Magnetic Stimulation (IV.67)	June 15, 2025
Electroconvulsive Therapy (I.120)	June 15, 2025

Strengthening health care through collaboration in Nebraska

We’re proud to be the only health insurance carrier to collaborate with state senators, the Nebraska Hospital Association and the Nebraska Medical Association on the new legislation improving the preauthorization process. By engaging in thoughtful discussion with these entities, we can create a more efficient and effective health care system.

Reimagining preauthorizations together

As we continue to improve the preauthorization experience, we’re thrilled to announce that even more enhancements are on the way. We’re developing innovative solutions to simplify and streamline the process, and we look forward to unveiling them on this page soon.

Thank you for your continued support and collaboration as we work together to enhance the preauthorization experience.

For more information, please see visit Happening Now.

Providers

Providers