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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.

Medical policy and pre-certification guidelines are specific to each member's Blue Plan.
Find a member's Blue Plan by Prefix »

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 5/2/19

General Manual

Medicare Advantage Policies

Policies and resources for Medicare Advantage-contracted providers.

Medicare Advantage Policies

Billing and Reimbursement

Includes billing and reimbursement requirements for FEP, home medical equipment, home infusion, hospice, mental health and more.
Updated 5/2/19

Billing and Reimbursement

Dental Policies and Procedures

Guidelines for dental health care professionals. This manual is in accordance with the current Nebraska statutes and provisions for dental care providers.
Updated 5/2/19

Dental Manual

Be informed when changes and updates are made to the policies and procedures.

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Note: Fee schedules are not published online at this time. Please contact your provider executive for more information.

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 »

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 »