CommercialPrior AuthHigh impact
MPC February 2023
Blue Cross Blue Shield of Nebraska·NE · Orthopedics, Pain Management, Cardiology +3 more·Medical Policy
Effective date
May 1, 2023
We identified it
Jun 19, 2026
Summary
Blue Cross Blue Shield of Nebraska is implementing several new medical policies effective May 1, 2023, requiring prior authorization for myoelectric upper limb prostheses, sympathetic nerve blocks, transcatheter aortic valve replacement, and ICD interrogations. Additionally, new pharmacy policies for specialized medications including Hemgenix, Relyvrio, and Tzield will require prior authorization starting March 1, 2023.
Action Required
Before May 1, 2023: Billing team must update prior authorization requirements in billing system for myoelectric upper limb prostheses, sympathetic nerve blocks, transcatheter aortic valve replacement, and ICD interrogations. Before March 1, 2023: Add prior authorization requirements for new medications Hemgenix, Relyvrio, Leqembi, Tzield, and Furoscix. Update encounter forms and EMR templates to remind providers of new preauthorization requirements. Claims submitted without required prior authorization will be denied.