At Blue Cross and Blue Shield of Nebraska (BCBSNE), member safety is a top concern. To ensure the necessity and appropriateness of procedures and services for our members, a prior authorization program is in place, which includes pre-service reviews.
The following services require pre-service review:
- Computed Tomography (CT/ CTA)
- Magnetic Resonance Imaging (MRI/MRA)
- Nuclear Cardiology
- Positron Emission Tomography (PET)
Please note: Plain radiology films, imaging studies performed in conjunction with emergency room services and inpatient hospitalizations are excluded from this requirement.
If the service is not pre-authorized, THE CLAIM MAY BE DENIED AND YOU MAY BE RESPONSIBLE FOR PAYMENT OF THE CHARGES.
Members Residing Within Nebraska
If you reside within Nebraska, contracting providers with BCBSNE are responsible for obtaining pre-service reviews for the services listed above. Nebraska-based providers have been notified about this change. If a contracting provider fails to obtain a pre-service review, he or she will be held responsible for any charges related to services performed.
Members Residing Outside of Nebraska
If you reside outside of Nebraska, you may see providers who practice outside of the state. It is important to note that BCBSNE does not have contractual agreements with out-of-state providers, and these providers may not be aware of the prior authorization and pre-service programs required for your health plan.
It is ultimately your responsibility to see that a pre-service review takes place when required. If your
provider does not submit a pre-service request for the services listed, the claims for those services will be denied and may be considered your liability.
To avoid possible denial and financial responsibility for the charges if a pre-service review is not done, please familiarize yourself with the services noted, and request that your provider submit a pre-service review if needed, by visiting medicalpolicy.nebraskablue.com.
Also note that if a pre-service review is submitted, but not approved, and the service is provided,
you may be held liable for charges for services determined to be not medically necessary.