CommercialPrior AuthMedium impact
MPC August 2024
Blue Cross Blue Shield of Nebraska·NE · Neurosurgery, Plastic Surgery, Pediatrics +2 more·Medical Policy
Effective date
Sep 1, 2024
We identified it
Jun 19, 2026
Summary
Blue Cross Blue Shield of Nebraska updated three medical policies requiring preauthorization: adjustable cranial orthoses for plagiocephaly (ages 3-18 months with specific criteria), peroral endoscopic myotomy for achalasia (age 18+ with type III spastic achalasia), and gastric POEM for gastroparesis (considered investigational). All require preauthorization with specific medical necessity criteria.
Action Required
By September 1, 2024: Billing team must update prior authorization requirements for cranial orthoses (patients 3-18 months with documented conservative therapy failure) and endoscopic myotomy procedures (adults 18+ with specific achalasia criteria). Update encounter forms to remind providers of documentation requirements including cephalic index measurements, Eckardt symptom scores, and conservative therapy attempts. Claims without proper preauthorization will be denied.