Medical Policies

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

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 » Launch MedPolicy Blue

MedPolicy Blue Features:

  • Secure login will be required for submitting preauthorizations. To streamline submissions, MedPolicy Blue will feature single sign-on integration with NaviNet to save you time while keeping data secure.
  • The ability to attach medical records within the tool. Preferred over faxing, uploading medical records prior to submission enables faster response on your preauthorization request.
    • At this time, only the preauthorization submission will require login. You will still be able to view and search policies without logging in.

Watch the Medical Policy Blue Enhancement webinar »

Behavioral Health Policies

Medical Policy for some Behavioral Health services listed in the Blue Cross and Blue Shield of Nebraska medical policy tool.

Refer to InterQual® Criteria to view medical necessity criteria for psychiatric services; including acute inpatient admissions, residential treatment center admissions, outpatient visits, and substance abuse services. InterQual® Criteria is evidence-based clinical decision support criteria developed by Change Healthcare, LLC and/or one of its subsidiaries.

Behavior Health Outpatient Form

  • This form is required to be submitted for more than 90 visits per calendar year.

Psych/Neuropsych Evaluation Request

  • Psych/Neuropsych testing in excess of four hours per calendar year must be preauthorized using this form.



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.