CommercialPrior AuthMedium impact
MPC August 2024
Blue Cross Blue Shield of Nebraska·NE · Neurosurgery, Plastic Surgery, Gastroenterology +2 more·Medical Policy
Effective date
Sep 1, 2024
We identified it
Jun 24, 2026
Summary
Blue Cross Blue Shield of Nebraska updated three medical policies requiring preauthorization: cranial orthoses for infants 3-18 months with plagiocephaly, peroral endoscopic myotomy (POEM) for achalasia in adults 18+, and gastric POEM for gastroparesis (investigational only). All require specific clinical criteria and prior authorization.
Action Required
Before September 1, 2024: Update billing system to require prior authorization for cranial orthoses (plagiocephaly cases) and POEM procedures for achalasia. Before December 1, 2024: Add prior auth requirement for gastric POEM procedures. Billing team must verify patient age, clinical criteria, and Eckardt scores before scheduling. Claims without proper preauthorization will be denied.