Happening Now

Please ensure you are submitting TIN/NPI of providers who are credentialed with BCBSNE. Most importantly, do not submit claims for newly-credentialed providers until you have the acceptance letter with the provider’s effective date.

For credentialing guidance, please visit NebraskaBlue.com/Credentialing or the Administrative Updates/Secure Forms link on the BCBSNE NaviNet landing page.

If the TIN or NPI have changed, refer to the Changes of address, telephone number and/or tax identification number, or adding practice locations policy.

Please be sure to add the appropriate modifiers as this additional information helps to make sure your claim gets paid correctly for the services rendered.

Modifiers indicate that a service or procedure performed has been altered by some specific circumstance, but not changed in its definition or code. They are used to add information or change the description of service to improve accuracy or specificity. Keep in mind that the use of modifiers should always follow the guidelines set by the American Medical Association (AMA) and other relevant coding authorities. 

The Risk Adjustment Department at BCBSNE will be transitioning to a new platform for requesting medical records. This transition will occur over the next several months.

The current fax number where Risk Adjustment Medical Record requests can be returned is 402-548-4664, this line will remain open during the transition time. 

The new Risk Adjustment medical record request letter will include a portal with an individual access code for healthcare provider offices to upload documents as well as an option to fax medical records to our new fax number 402-506-7032.

We appreciate your patience as we transition to this new platform. 

Effective Jan. 1, 2025, BCBSNE no longer accepts paper (faxed or mailed) timely filing override requests. As part of our ongoing transition to paperless processes, all timely filing override requests must be submitted via NaviNet.

Please note that we will no longer process or return paper timely filing override requests received via fax or mail.

The Nebraska Applied Behavior Analyst (ABA) Board has announced that all Behavior Analysts practicing in Nebraska must obtain state licensure within 90 days following Sept. 2, 2024.

BCBSNE will update licensure requirements for this provider type during recredentialing. 

Please be sure to update your professional license information in the personal information section in the CAQH Provider Data Portal.

For those applying for initial credentialing please have your license number before applying. BCBSNE is returning applications if licenses are not included on the application. If you have already submitted your application, please reapply when you receive your license. Previous board certification will still be required. 

Behavior Analysts who are due for recredentialing, without a license on file, participation will be terminated until a new application with license and previous board certification will be needed.

Our Medicare pricing tool utilizes the NPPES data registry to link the Medicare Number/CCN with the NPI data listed in the registry. If there is a discrepancy between the data in the registry and what is submitted on the claim, the claims may be delayed or potentially returned. Therefore, it is crucial for providers to ensure accurate updates to the NPPES and to deactivate outdated information.

Nearly a year ago, as a result of the Change Healthcare cyberattack that suspended claims processing services for many providers, BCBSNE extended financial assistance, facilitated transitions to new clearinghouses and allowed timely filing extensions when appropriate. Please note that as of Oct. 24, 2024, we have returned to adhering to contractual timely filing limits for all providers.

Effective Jan. 2, 2025, BCBSNE will be retiring the Urgent Radiology Preauthorization Request phone number 402-982-8870 or 888-263-3870. 

Please update your records accordingly and direct all future radiology-related inquires via NaviNet.

We appreciate your cooperation and understanding. 

When patient care extends into the new year, following our Split-Year Claim Submission policy ensures your claims are not rejected, returned or delayed due to billing errors.

To help take advantage of auto-adjudication and reduce the number of claim returns, FEP is updating their processes to opt out of a subset of coding edit processing rules. Currently if a claim hits one of these rules, the entire claim may be returned with a specific Return Reason. Effective Nov. 22, 2024, individual lines will be denied, and the remainder of the claim will process and pay accordingly.  This change affects only the subset of coding edit returns. Claims will continue to be returned for other reasons and does not apply to other lines of business.

Processing Example:

• Previously: claim was returned with ‘the procedure code(codes) are missing, not legible or invalid as billed’
• Effective immediately: Claim will not be returned. Claim will process and pay accordingly except for the line(s) that are not appropriate, which will deny with EOB Remark code of:
  • T485- procedure code not compatible with patient's age- member liable OR
  • T486- procedure code not compatible with patient's age- provider liable

Please review your claim line item details for more information on the specific reason for the denial. To ensure you do not miss the timely filing deadline, please correct the error(s) and submit a corrected claim.

Effective Nov. 1, 2024, providers will need to contact us directly to withdraw a preauthorization request. If you need to withdraw a request, please call Customer Service. We’re here to assist you.

To avoid delays in preauthorization's, please ensure you click the Policy Code Link when submitting an outpatient authorization after inputting the CPT/HCPC code. This step is necessary to successfully access the review criteria. In instances where the entered code does not retrieve the anticipated policy, please select “No Policy Applies.” Failure to select the policy code will result in delays in the review and decision of the preauthorization request.

As we posted to Happening Now on Oct. 21, effective Oct. 28^th, the following changes were implemented:

• Only the numeric portion of the ID number needs to be entered for preauthorization requests. The alpha prefix is no longer required. However, claims must still be submitted using the full alpha-numeric ID number.
• Notes or an attachment of medical records must be added before launching InterQual^®. You will not be required to submit both.
• For commercial business, when selecting criteria guidelines in InterQual please confirm you are not selecting the Medicare Advantage (MA) criteria. 

Important: All BCBSNE MA members will receive new ID numbers starting Jan. 1, 2025. Please ensure you are using their new ID number for services to be received on or after Jan. 1, 2025.

We made a small but important enhancement to the Claim Appeal statuses in NaviNet. Now when you submit an appeal the status will change to “In Review” once your appeal is received. Although we can’t provide interim statuses on NaviNet, this change ensures you know your request is being processed. Once BCBSNE responds, the status will update to “Closed."

Below is a screenshot showing the new status button on the NaviNet appeal page.

 

For more information and guidance, please view our eLearning videos.

Since 1960, the Blue Cross and Blue Shield Federal Employee Program (FEP) has been proud to provide coverage to federal employees and their families in the Federal Employees Health Benefits (FEHB) Program. Starting in 2025 with the introduction of the Postal Service Health Benefits (PSHB) Program, we're excited to continue providing our coverage to USPS employees and their families. You will find more information regarding this change, and how it affects you, in December’s Provider Bulletin!

Emails are handled in the order received; however, emails are not worked unless the below information is included. 

• Provider name, NPI and TIN
• Claim numbers (if applicable)
• Member name and ID
• DOS
• Expected outcome or reimbursement

 
Additionally, the appropriate steps MUST be followed first BEFORE submitting an escalation request to this email box. 

Step One: NaviNet^®

Please access NaviNet for all member, claim, authorization and appeal needs. If you do not have access to NaviNet please register by following the steps under Provider Academy.

Step Two: Contact

If NaviNet is unsuccessful, please use the claims investigation tool located in NaviNet.
 
Step Three: Escalating

For claim escalation needs that you are unable to resolve through NaviNet or Customer Service Claims Investigation, you can email this email box and include why NaviNet or Claims Investigation was not successful including the inquiry number from Customer Service.

 
FOR FEE SCHEDULES:

All fee schedules are available in NaviNet and will NO LONGER be available via CSC, email or inquiry. 

If you are affiliated with a PHO, you must obtain the fee schedule from the PHO.

FOR TIMELY FILING:

Please submit your request via NaviNet using the Timely Filing form. 

Please remember – COB is not a member ID exception please complete the reconsideration form on NaviNet if another insurance was billed, recouped or denied the claim and you then submitted to BCBSNE.  

Provider Executives no longer address COBs submitted incorrectly on a timely filing form.  

We are pleased to announce a significant partnership between TriWest, an affiliate of the BCBS Association, and Blue Cross Blue Shield of Nebraska (BCBSNE). TriWest has been awarded the Western Region TRICARE contract to be effective 1/1/2025.  Health Net will no longer be the fiduciary. Thus, to continue participation with TRICARE, providers will need to sign with TriWest. 

TriWest is actively expanding its network in Nebraska via BCBSNE and is distributing documents to providers through DocuSign. For those already part of NEtwork Blue, BCBSNE's credentialing process will suffice, meaning there are no additional credentialing steps. We urge you to promptly review and sign the contract sent to you, which includes a DocuSign link sent from dse_NA4@docusign.net; it's possible this email was directed to your spam folder. If a new contract is needed or if you haven't received yours, please contact us without delay at BCBSNEProviderContracting@NebraskaBlue.com for resolution. Furthermore, if you decide not to join the network, please inform us so we can keep our records current. 

For any inquiries or assistance, please feel free to contact us. 

Frequently Asked Questions (FAQ) - TRICARE 

Q: I’m already contracted with TRICARE; do I need to take any action? 
A: Yes, all contracts with TRICARE’s previous administrator Health Net will expire at the end of 2024. To be considered In-Network for TRICARE in 2025, you will need to sign an agreement with TriWest. 

Q: Is Blue Cross and Blue Shield of Nebraska (BCBSNE) collaborating with TriWest? 
A: Yes, TriWest, which is an affiliate of the BCBS Association, has been awarded the Western Region TRICARE contract to be effective 1/1/2025. BCBSNE and TriWest are in partnership to establish a comprehensive network for TRICARE beneficiaries. BCBSNE oversees the management of the provider network and the credentialing process for healthcare providers within Nebraska. 

Q: How can I access the fee schedule related to my TRICARE agreement? 
A: The fee schedule is available on the official Military Health System website. You can view the rates and reimbursement details for TRICARE by visiting the TRICARE Allowable Charges page under the Rates and Reimbursement section. (TRICARE Allowable Charges | Health.mil) 

Q: In case of any issues with my TRICARE contract, whom should I contact? 
A: For any contract-related inquiries or issues, please reach out via email to BCBSNEProviderContracting@NebraskaBlue.com. 

Answers from AAHAM:

• Not all TriCare plans have OON benefits, it is important to check benefits
• TriCare refers to contracted providers
• Prior auths will be honored for contracted providers
• Providers will not need to be recredentialed as long as TriCare credentialing requirements are met