CommercialPrior AuthMedium impact
MPC May 2022
Blue Cross Blue Shield of Nebraska·NE · Urology, Neurosurgery, Orthopedics +3 more·Medical Policy
Effective date
Aug 1, 2022
We identified it
Jun 24, 2026
Summary
Blue Cross Blue Shield of Nebraska has updated multiple medical and pharmacy policies with new prior authorization requirements and coverage criteria. Several new medical policies are being added, including prostate rectal spacers with specific criteria, while spinal cord tethering and piriformis syndrome surgery are now considered investigational.
Action Required
By August 1, 2022: Billing team must update prior authorization workflows for all new and revised policies. Implement preauth requirements for prostate rectal spacers (SpaceOAR), spinal cord tethering procedures, and piriformis syndrome surgery. Update pharmacy prior auth processes for new medications including Fyarro, Lutathera, Pluvicto, Enjaymo, and Pyrukynd effective June 1, 2022. Review all coverage criteria and ensure documentation requirements are met before submitting claims.