Medical Policy Updates

The Blue Cross and Blue Shield of Nebraska (BCBSNE) Medical Policy Committee (MPC) is composed of practicing physicians within the BCBSNE network. The committee utilizes contract criteria summarized online at to determine whether a new technology or new application of an existing technology is scientifically valid or investigative.

Updates will be posted after each meeting.





Updates to the Prior Authorization Submission Service in Med Policy Blue

Previously, when prior authorizations were submitted online, providers received a cover sheet which included a 32-character reference number. Now, when prior authorizations are submitted online, providers will be given an event number beginning with an "S" to reference their medical prior authorization submissions. This event number is specific to the submitted prior authorization request and will streamline the process of checking the status of a prior authorization. 

Prior authorization requests submitted on pharmacy policies will continue to return a 32-character reference number. This is also true for any cases in which we are unable to match the member's Blue Cross and Blue Shield of Nebraska Identification Number. Contact Customer Service at 1-800-635-0579 for requests to expedite prior authorization reviews or to check the status of a submitted prior authorization. 

Another new feature of the online Prior Authorization submission service in Med Policy Blue is a Frequently Asked Questions (FAQ) tab that can assist with common questions regarding submitting medical and pharmacy prior authorizations. Please use the Contact Us tab for any questions that are not addressed in the FAQ. 

Medical Policy Drafts

Effective May 1, 2015

Effective May 15, 2015



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.