CommercialPrior AuthHigh impact
MPC November 2021
Blue Cross Blue Shield of Nebraska·NE · Orthopedics, Urology, Ophthalmology +7 more·Medical Policy
Effective date
Mar 1, 2022
We identified it
Jun 19, 2026
Summary
Blue Cross Blue Shield of Nebraska is implementing multiple new prior authorization requirements and policy updates effective March 1, 2022, including mandatory prior auth for inpatient joint replacements, new BPH treatment policies, genetic testing updates, and various specialty procedure authorizations.
Action Required
By March 1, 2022: Update billing system to require prior authorization for all inpatient hip, knee, and shoulder arthroplasty procedures. Configure system to NOT require prior auth for outpatient joint procedures. Update authorization workflows for BPH treatments (Urolift now covered with criteria, multiple procedures now investigational), intravitreal corticosteroid implants, genetic testing panels, ECT, DME, and apheresis procedures. Train staff on new investigational designations that will result in claim denials. Access full policy details that will be posted by February 1, 2022.