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
July 2025
- GP-X-029 Provider Audit Program
- GP-X-030 Prepayment Audit
- MA-X-051 Contracted Provider Appeals
- MA-X-073 MA Part B Drug Prior Authorization List
- MA-X-093 MA Auto Approval for SNF Admissions
- MA-X-095 MA Readmission Quality Program
- MA-X-096 MA Provider Audit Program
- MA-X-097 MA Prepayment Audit
June 2025
- No updates
May 2025
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 »