CommercialPrior AuthHigh impact
MPC November 2021
Blue Cross Blue Shield of Nebraska·NE · Orthopedics, Urology, Ophthalmology +5 more·Medical Policy
Effective date
Mar 1, 2022
We identified it
Jun 24, 2026
Summary
Blue Cross Blue Shield of Nebraska is implementing multiple new prior authorization requirements and coverage changes effective March 1, 2022, including mandatory prior auth for inpatient joint replacements, new BPH treatment policies, and extensive genetic testing updates.
Action Required
By March 1, 2022: Billing team must update prior authorization workflows for all inpatient hip, knee, and shoulder arthroplasty procedures. Update billing system to require prior auth for new medical policies including BPH treatments, intravitreal corticosteroid implants, genetic testing panels, ECT, and DME. Review full policy documents when posted by February 1, 2022. Front desk staff must verify prior auth requirements before scheduling affected procedures. Claims without proper prior authorization will be denied.