BCBSNE Provider Procedures

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 »