Policies and Procedures

Blue Cross and Blue Shield of Nebraska’s (BCBSNE) policies and 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:

  • General policies and procedures
  • Billing and reimbursement requirements
  • Guidelines for dental health care professionals

How-To Guide for Providers

Current Updates

October 2023

  • Update to Blue Distinction Centers - GP-IA-001 (Oct. 16, 2023)
  • Update to Interim Billing - PR-I-009 (Oct.17, 2023)

September 2023

  • Update to Readmission Policy
  • Update to Medicare Advantage Medical Policy

August 2023

  • Update to Refund Offsetting GP-X-095
  • Update to Telehealth GP-X-016
  • Update to Timely Filing Limit GP-X-046

Medicare Advantage Policies

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

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 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 »