Provider FAQs

Access the list of services, procedures and medical policies requiring authorization (certification) prior to providing the service.

Search codes on MedPolicy Blue »

The most recent medical policy updates are available on the Alerts and Updates page.

All investigative denials will be considered provider liability, even if preauthorization is done and denied as being investigative. 

Per our Blue Cross and Blue Shield of Nebraska (BCBSNE) Provider Policies and Procedures, a provider may hold a member financially liable for a medical necessity or investigative denial only if:

• The provider has advised the member – prior to services being provided – that the member may be financially liable for the services provided
• The provider has given the member an estimate of financial liability

For a situation where a patient requests services considered not medically necessary and/or investigative and agrees in writing to be responsible for the non-covered charges, the provider must file a paper claim with the signed patient waiver. If a claim is filed without a waiver and the claim is denied as provider liability (but a waiver was signed prior to the claim being filed), a provider may submit a reconsideration with the waiver.

If a written agreement cannot be obtained, verbal notification may be given by the provider. The verbal notification must be documented in the patient’s medical records at the time the notification is given, and evidence provided to BCBSNE. For all other balances, the provider agrees not to bill or collect any amount from the member.

Preauthorization requests should be submitted through our online portal, NaviNet. However, there are four exceptions where providers should use the Universal Prior Authorization Request forms.

• Hospice services 
• Newborns needing services who are not yet added to the benefit plan
• Member lookup issues (when a member’s information isn’t found in NaviNet)
• Out-of-Network (OON) or Out-of-State (OOS) providers (only when the OON or OOS providers do not have access to NaviNet)
  

These exceptions help ensure timely processing and support care coordination when digital tools aren’t applicable. 

The Universal Prior Authorization forms are available on our Preauthorization page, with clear buttons to guide you to the correct option.  

Reminders:

For Preauthorization Requirements 

To verify if preauthorization is required for a specific procedure code providers should utilize MedPolicy Blue. 

Out-of-Area Members  

For out-of-area members, please select Pre-Service Review for Out-of-Area Members workflow in NaviNet.

The Continuation of Care indicator should only be selected when a provider is requesting that BCBSNE honors a prior authorization issued by the member’s previous health plan for the same service under the same benefit type.

This request applies during the transition period, defined as the first 90 days following the start of BCBSNE coverage.

Supporting documentation verifying the prior authorization from the previous health plan must be submitted at the time of the request.

To support faster, more efficient service BCBSNE is updating how providers access preauthorization status.

Effective Dec. 1, 2025, preauthorization status is available only through our digital tools, which include:

• NaviNet (for requests submitted through NaviNet) 
• Online preauthorization platform (for requests submitted via physical form)
• Automated phone system (for quick updates while our CSC team assists with complex needs)

Checking Status via NaviNet^®

To check the status of a preauthorization request submitted via NaviNet, please follow these steps:

1. Log in to NaviNet.
2. Under Workflows for this Plan, select Preauthorization or Precertification.
3. Select the ordering provider and click the submit button.

Note: The rendering facility will be able to view the status only if the ordering provider identified the rendering facility when entering the request in NaviNet.

4. Click the Authorization List icon from the menu on the left side of the screen to view the authorizations.

For more guidance refer to the Preauthorization/Precertification elearnings on the provider academy.

Checking Status via IVR

Providers can use the automated phone system (IVR) to check the status of preauthorization requests by entering a valid NPI and member ID. The IVR will provide:

• All preauthorizations for the member from the past six months, including: 
  
  • Pending requests
    
  • Approved requests
    
  • Denied requests
    Note: For denied requests, the IVR will provide the authorization number only. For full denial details, providers should refer to the denial letter.

If you need additional information about a preauthorization that was submitted by another provider, please reach out directly to the ordering provider for details. They will be able to share the relevant information with you.

Providers will need to contact us directly to withdraw a preauthorization request. If you need to withdraw a request, please call Customer Service. We’re here to assist you.

To avoid delays in preauthorization's, please ensure you click the Policy Code Link when submitting an outpatient authorization after inputting the CPT/HCPC code. This step is necessary to successfully access the review criteria. In instances where the entered code does not retrieve the anticipated policy, please select “No Policy Applies.” Failure to select the policy code will result in delays in the review and decision of the preauthorization request. 

Please refer to the provider procedure below that outlines the Medicare Advantage (MA) preauthorization requirements.

MA Prior Authorization and Precertification Requirements

BCBSNE requires precertification for all acute (non-emergency) inpatient and observation admissions to hospitals or facilities on or before the first day of admission. Unplanned admissions can be submitted on the first business day following admission.

For participating (PAR) providers: Please submit precertification requests online via Navinet. If NaviNet submission isn’t possible you may use the Universal Prior Authorization Request form. These exceptions include hospice services, newborn: If not yet on the plan, out-of-state FEP members, or cases where member information isn’t found in NaviNet.

For out-of-network and out-of-state providers only: If you do not have access to NaviNet you may submit precertification requests via the Universal Prior Authorization Request forms. Access this online form by visiting our preauthorization page.

Please visit our preauthorization page for more details.

To ensure accurate review, and timely and appropriate care, BCBSNE requires a new authorization request for any outpatient service that needs to continue beyond the originally approved dates. This applies to all outpatient services, including Home Health.

Effective immediately
Extensions cannot be processed under the original authorization. A new authorization request must be submitted for the additional dates or visits.
(Note: This requirement does not apply to inpatient services.)

Submitting a new authorization request
The fastest and most reliable way to submit an authorization request is through NaviNet^®.

If electronic submission is not possible, providers may use the Universal Prior Authorization Request Form for approved exceptions.

Steps to submit an authorization request via NaviNet

1. Log into NaviNet.
2. Under Workflows for this Plan, select Preauthorization or Precertification.
3. Enter the required details for the new request and submit.
4. Attach updated clinical documentation supporting the need for continued services.

For more guidance, visit the Preauthorization page or refer to the Preauthorization/Precertification eLearnings in the Provider Academy.

You should use the Universal Prior Authorization Request forms for the following exceptions:

• Hospice services
• Newborns requiring services who have not yet been added as a permanent member of the benefit plan
• Member lookup exception: when a member’s information is not found in NaviNet

Why are these exceptions in place?
These exceptions help ensure timely processing and support care coordination when standard digital tools are not applicable.

Where can I find the form?
The Universal Prior Authorization Request forms are available on the preauthorization page. Specific buttons will guide providers to the appropriate option for these exceptions.

Appeals (medical records only)

• 888-492-4944
• 402-548-4684

Commercial (medical records only)

• 402-392-4111
• 800-991-7389

Medicare Advantage Pre-Cert (inpatient medical records only)

• 1-866-422-5120

Can I send preauthorization requests to these fax numbers?
No. These fax lines are for medical records only. If preauthorization requests are sent to these numbers, they will not be processed. Providers will receive a faxed response indicating the request was misrouted.

Out-of-state and out-of-network providers can submit preauthorization requests using one of two methods:

• Preferred Method: If you have access to the provider portal, please use it to submit your request.
• Alternative Method: If you do not have portal access, you may use the Universal Prior Authorization Request form, available on the preauthorization page. Clear navigation buttons will guide you to the appropriate option for these exceptions.
  
   

If you are not listed as the ordering provider, servicing provider or facility provider on the submitted preauthorization, you will not be able to view it in NaviNet. 

If you need information about a preauthorization that was submitted by another provider, please reach out directly to the ordering provider for details. They will be able to share the relevant information with you.

You need to ensure your vendors have NaviNet access by November 17, because fax submissions will be discontinued.

Can offshore vendors access NaviNet?

• Vendors that are 100% offshore with no U.S. address cannot register or reach the NaviNet login page.
• Vendors with a U.S. office address can register using that address, but access may still be blocked based on geographic location or firewall restrictions.

Why are these restrictions in place?
NaviNet is intended for use within the United States only. Our policy states:

• Services and Materials are provided in the U.S. for access and use in the U.S. only.
• Access outside the U.S. is at the user’s own risk and subject to U.S. export controls.
• None of the Services, Materials, or underlying technology may be downloaded or exported outside the U.S.

Where can I find more information?

• Visit our preauthorization page for details on NaviNet registration and upcoming changes.