CommercialPrior AuthHigh impact
MPC August 2022
Blue Cross Blue Shield of Nebraska·NE · Urology, OB-GYN, Pain Management +2 more·Medical Policy
Effective date
Aug 17, 2022
We identified it
Jun 24, 2026
Summary
Blue Cross and Blue Shield of Nebraska updated multiple medical policies requiring preauthorization for MRI prostate screening, radiofrequency ablation for uterine fibroids, spinal cord stimulation for diabetic neuropathy, and several new pharmacy policies. All changes have specific clinical criteria that must be met for coverage approval.
Action Required
By August 17, 2022: Billing team must update prior authorization requirements for MRI prostate screening (ages 40-74 with PSA >3 or abnormal DRE, ages 75+ with PSA ≥4), radiofrequency ablation for uterine fibroids <10cm (laparoscopic) or <7cm (transcervical), spinal cord stimulation for peripheral diabetic neuropathy, and new pharmacy drugs Norliqva, Tavneos, Livtencity, Camzyos, and Oxbryta. Update encounter forms and EMR templates to prompt providers for required clinical documentation. Claims submitted without proper preauthorization will be denied.