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Providers

Policies and Procedures

The in-network policies and procedures manuals provide important information for physician and health care professionals, facilities, psychiatric, and dental providers. View the specific manual to learn more.

Medical policy and pre-certification guidelines are specific to each member's Blue Plan.
Find a member's Blue Plan by Prefix »

General Policies and Procedures Manual

Find out member/provider responsibilities, BlueCard, FEP, claims payments and refunds, quality, network requirements, appeals, non-covered services and more.
Updated 3/22/19

General Manual

Medicare Advantage Policies

Policies and resources for Medicare Advantage-contracted providers.

Medicare Advantage Policies

Billing and Reimbursement

Includes billing and reimbursement requirements for FEP, home medical equipment, home infusion, hospice, mental health and more.
Updated 3/22/19

Billing and Reimbursement

Dental Policies and Procedures

Guidelines for dental health care professionals. This manual is in accordance with the current Nebraska statutes and provisions for dental care providers.
Updated 11/6/17

Dental Manual

Be informed when changes and updates are made to the policies and procedures.

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Note: Fee schedules are not published online at this time. Please contact your provider executive for more information.

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 »

Assistant Surgery Guidelines
BCBSNE follows CMS’s Post-Op and Assistant Surgery Policy. CPT codes with an indicator of 2 allow an assistant. CPT codes with indicators 0, 1, and 9 in the assistant surgery column do not allow payment for assistant surgeon. If the CMS indicator is 0 and the service is denied, you may submit an appeal along with the appropriate medical record documentation and the claim will be reviewed.

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 »