Our NEtwork BLUE policies and procedures manual provides important information for the following BCBSNE provider types:
- Physician and Health Care Professionals
- HME Home Infusion
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.
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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:
- For help with clinical questions, call Medical Support at 402-982-8870 or 888-236-3870.
- To request a password reset for Clear Coverage or for help navigating the Clear Coverage tool, call Provider Solutions at 402-982-7711, select option 4 then option 1.
- To determine the status of a preauthorization or to ask questions about a denial, call Customer Service at 800-642-8516.
If you are an out-of-state provider, please use the Preauthorization Request form for all preauthorizations or call Medical Support at 402-982-8870 or 888-236-3870.
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.
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