Policies and Procedures

NEtwork BLUE

Our NEtwork BLUE policies and procedures manual provides important information for the following BCBSNE provider types:

  • Physician and Health Care Professionals
  • Facilities
  • HME Home Infusion
  • Psychiatric
Download Manual » 


Medical Policies

A uniform set of medical policies, including criteria for medical necessity of certain DME/HME products, established by the Blue Cross and Blue Shield of Nebraska Medical Policy Committee.

View Medical Policies » Our new medical policy tool, MedPolicy Blue, is now available! Learn more.

Medical Policy Updates » 

Services, Procedures & Medical Policies Requiring Prior Authorization »

Radiology Preauthorization Program through Clear Coverage

Effective Oct. 1, 2016, BCBSNE will perform radiology reviews for the following services using Clear Coverage, a web-based preauthorization tool.

  • Computed Tomography (CT/CTA)
  • Magnetic Resonance Imaging (MRI/MRA)
  • Nuclear Cardiology
  • Positron Emission Tomography (PET)

Beginning Oct. 1, 2016, if the services listed above are not preauthorized, claims may be denied and you may be responsible for payment of the charges.

Please note: Plain radiology films, imaging studies performed in conjunction with emergency room services and inpatient hospitalizations are excluded from this requirement.

Visit medicalpolicy.nebraskablue.com/clearcoverage to create your Clear Coverage user account today. Once you create your account, log in at nebraskablue.com/clearcoverage.

For additional information on Clear Coverage, please utilize the following resources:

Dental Policies

Licensed dental health care professionals in accordance with the current provisions of Nebraska Revised Statutes. The Dental Benefits by Plan Code Documentation explains the different coding issues for in- and out-of-network benefits, type of coverage and coinsurance amounts, deductibles, calendar years and specific notes of coverage.

View Dental Policies »



The percentage of the bill you pay after your deductible has been met.


A fixed amount you pay when you get a covered health service.

Tiered benefit plan

A health care plan featuring multiple levels of benefits based on the network status of a particular provider. 


The annual amount you pay for covered health services before your insurance begins to pay.

emergency care services

Any covered services received in a hospital emergency room setting.


Includes behavioral health treatment, counseling, and psychotherapy

in-network provider

A provider contracted by your insurance company to accept an agreed upon payment for covered services. 

OUT-OF-network provider

A term for providers that aren’t contracting with your insurance company. (Your out-of-pocket costs will tend to be more expensive if you go to an out-of-network provider.)


Your expenses for medical care that aren’t reimbursed by insurance, including deductibles, coinsurance and co-payments.


If you can afford health insurance, but choose not to buy it, you must have a health coverage exemption or pay a tax penalty on your federal income tax return.


The amount you pay to your health insurance company each month. 

Preventive services

Health care services that focus on the prevention of disease and health maintenance.


Services and devices to help you recover if you are injured or have surgery. This includes physical, occupational and speech therapy.

special enrollment period

The time after the Open Enrollment Period when you can still purchase health insurance only if you have a qualifying life event (losing other health coverage, having a baby, getting married, moving).


A physician who has a majority of his or her practice in fields other than internal or general medicine, obstetrics/gynecology, pediatrics or family practice.