CommercialPrior AuthHigh impact
MPC November 2021
Blue Cross Blue Shield of Nebraska·NE · Orthopedics, Urology, Ophthalmology +9 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 effective March 1, 2022, including inpatient joint replacements, BPH treatments, eye implants, genetic testing, and various other procedures. Most new policies require preauthorization with specific medical necessity criteria.
Action Required
By March 1, 2022: Update billing system to require prior authorization for all inpatient hip, knee, and shoulder arthroplasty procedures. Configure prior auth requirements for BPH treatments (Urolift, Rezum), intravitreal corticosteroid implants, genetic testing panels, ECT, DME, and apheresis procedures. Train staff on new preauthorization workflows and update encounter forms to prompt providers. Claims submitted without required prior authorization will be denied.