CommercialPrior AuthHigh impact
MPC December 2025
Blue Cross Blue Shield of Nebraska·NE · Cardiology, Cardiothoracic Surgery·Medical Policy
Effective date
Apr 1, 2026
We identified it
Jun 19, 2026
Summary
Blue Cross Blue Shield of Nebraska is expanding preauthorization requirements for electrophysiology testing and cardiac catheter ablation procedures, and updating pacemaker/defibrillator policies. Both policies will require InterQual criteria review for preauthorization starting April 1, 2026.
Action Required
By April 1, 2026: Billing team must update systems to require prior authorization using InterQual criteria for all listed electrophysiology testing, cardiac catheter ablation, pacemaker, and defibrillator procedures for BCBS Nebraska patients. Update encounter forms and staff training for new preauth requirements. Providers must ensure documentation meets InterQual criteria before scheduling procedures. Claims will be denied without proper preauthorization.