Toddler recovers in hospital pediatric intensive care unit and plays with a toy yellow bus


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.

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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 09/30/2022

General Manual

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Dental Policies and Procedures

Includes guidelines for dental health care professionals such as coordination of benefits, policy and coding, appeal overviews and more.
Updated 9/30/21

Dental Manual

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Billing and Reimbursement

Includes billing and reimbursement requirements for FEP, home medical equipment, home infusion, hospice, mental health and more.
Updated 09/30/2022

Billing and Reimbursement

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Medicare Advantage Policies

Includes policies and procedures, resources and pharmacy management for Medicare Advantage-contracted providers.

Medicare Advantage Policies

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Medical Record Standards

Includes record management, documentation tips, general medical record documentation, required documentation for specific services and sending medical records to BCBSNE.
Updated 05/17/21

Medical Record Standards

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Definitions, Terms and Abbreviations

Includes definitions of terms for healthcare providers to reference.
Updated 06/30/22

Definitions, Terms and Abbreviations

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 »

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 »