CommercialPrior AuthMedium impact
MPC April 2023
Blue Cross Blue Shield of Nebraska·NE · Oncology, Gastroenterology, Cardiology +4 more·Medical Policy
Effective date
Jul 1, 2023
We identified it
Jun 19, 2026
Summary
Blue Cross Blue Shield of Nebraska updated multiple genetic and oncology testing policies, all requiring preauthorization effective July 1, 2023. The changes establish specific medical necessity criteria for various genetic tests including cancer susceptibility, tumor profiling, and inherited disorder testing.
Action Required
Before July 1, 2023: Billing team must update system to require prior authorization for all genetic and molecular testing codes listed in the policy. Update encounter forms and EMR templates to include medical necessity criteria for each test type. Train providers on specific documentation requirements for each genetic test category. Claims will be denied without proper preauthorization and documentation of medical necessity criteria.