BCBS Nebraska is updating the Medicare Advantage (MA) provider appeals process.
Effective October 17, 2026, providers will no longer be able to submit an appeal for services that required prior authorization but were rendered without obtaining the required authorization. Claims denied due to missing prior authorization will not be eligible for appeal or further medical necessity review, and services rendered following a prior authorization denial will no longer be eligible for reconsideration. Provider Update September 2026 | BCBSNE
Additionally, effective January 1, 2027, the payer will reduce radiology and laboratory MA reimbursement rates consistent with CMS updates. Radiology rates will be the CMS reimbursement rate less 20% and laboratory rates will be the CMS reimbursement rate less 30%. For more information: Medicare Advantage | BCBSNE
- Sarah Stewart, Vice President, RCS