Happening Now

Please continue to watch Happening Now for updates.

Stay informed with the latest updates on Medicare Advantage plans.

CAQH Provider Data Portal planned system maintenance: May 24th- 26th (May 6, 2024)
The CAQH Provider Data Portal will undergo system maintenance to ensure continued reliability and performance of solutions. Downtime is scheduled to begin at 7:00 pm on Friday, May 24th and continue through 7:00 am on Sunday, May 26th.  During this time, all Provider Data Portal solutions we be unavailable. You will not be able to access the https://proview.caqh.org/Login website, the SFTP, or APIs, and may experience delays in the delivery of extract and return rosters. BCBSNE will not be able to receive any updates during this downtime as well. 

Top three claim return reasons

To help providers submit accurate claims and take advantage of auto-adjudication, BCBSNE continues to rank the top three reasons for claim returns: 

 

  1. The provider’s name and credentials, Federal Tax Identification number and/or NPI are missing. 

    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. 

  2. The Federal Tax Identification number (TIN) and/or the NPI number for the Provider, Rendering or Referring, is not effective for the date of service.

    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.


  3. The required BCBS subscriber identification number is missing or invalid. 

    Please verify this information an resubmit your claim with the complete identification number as it appears on the member’s BCBS identification card in the correct ID number field.

    It is recommended that you photocopy the patient’s member ID card at every visit to ensure you have the most up-to-date coverage information.

    NebraskaBlue.com/Providers/Policies-and-Procedures/General/Identification-Cards

NaviNet® - What is it and why should I use it

NaviNet is an easy-to-use, secure portal that links you, our provider to us, BCBSNE. With NaviNet web-based solutions we can share critical administrative, financial, and clinical data in one place.

This tool helps you manage patient care with quick access to:

  • Verify member eligibility
  • Request an authorization
  • Request preservice review for out-of-area members
  • View claim and payment details
  • View documents
  • Investigate and follow-up on claim investigations
  • Appeal a claim and view existing appeals
  • Access remittance advice details
  • Access fee schedules
  • View claim return letters
  • Review your provider information

For written instructions on how to access the information above, please download our NaviNet Guide on our NaviNet Quick Access webpage.

If you prefer eLearning video tutorials with step-by-step instructions these are available in our Provider Academy. Visit NaviNet Quick Access for FAQs for our most commonly asked questions to improve your self-service experience.

NaviNet helps speed up the provider-health plan connection and can often replace paper transactions. If you are not a NaviNet user, learn more about NaviNet

Claim Return, Reconsideration and Appeal letters are going paperless in 2024 (April 25, 2024)

Beginning Apr. 1, 2024, Blue Cross Blue Shield Nebraska will no longer mail claim return letters to our participating network health care professionals and facilities.

Effective May 15, 2024, we will be adding Reconsideration and Appeal letters to this paperless process.

BCBSNE will instead post them on NaviNet under patient documents. There is an eLearning video for your reference by clicking here ➡️ eLearning - Provider Academy.

If you cannot locate the letter(s), please reach out using the Claims Investigation tool explaining what you did to locate the letter(s) and the issue you encountered.

Blue Cross and Blue Shield of Nebraska will be closed on Monday, May 27th in observance of Memorial Day. Please use NaviNet for your eligibility, benefits, and claim status needs during this time.

Did you know? 

When submitting a claim, the correct provider taxonomy must be on the claim for it to process. This is the taxonomy you were credentialed with and could be different from NPPES. Please see Claims FAQs on our Provider Academy

What is provider taxonomy? Provider taxonomy is a set of 10 alphanumeric characters that define specific specialty categories for providers (individual, group, or institution). There are different levels defined in the code set, including Provider Grouping, Classification and Area of Specialization. Providers may identify under more than one code set. 

How does this affect you? Please ensure you are submitting the correct taxonomy. This information is needed for credentialing, delegated updates, and claims processing. It is important that the taxonomy matches the credentialed taxonomy on file with BCBSNE. When the appropriate information is not submitted, the claim will be returned. 

For newly credentialed providers, please reference your letter with effective date and taxonomy code listed. An excellent source for more information on taxonomy is www.nucc.org.

G0109 follows the same guidelines as other telehealth codes and requires modifier 95 with a place of service 02 or 10. In addition, the service must be billed by an approved telehealth provider.

BCBSNE has made the decision to transition away from Change Healthcare for Dental clearinghouse services. 

Vyne and DentalXchange clearinghouses are already set up with BCBSNE making the transition easier for you. BCBSNE continues taking steps to become paperless, it is important for our dental providers to align with a clearinghouse to both submit claims as well as receive remits. 

Below are the steps to take: 

Once you are connected, fill out the Electronic Remittance Advice Form available here: Find A Form and email completed forms to HealthNetworkRequests@NebraskaBlue.com.

Once the form is received the process can take up to 5 days. If you need further assistance or have additional questions, please reach out to our provider executive team at ProviderExecs@NebraskaBlue.com

You may receive requests from BCBSNE or BCBSNE vendors to review medical charts for your patients. As a participating provider, your contract requires you to permit BCBSNE and our business partners to inspect, review and obtain copies of such records upon request at no charge to BCBSNE or our members. 

We appreciate you working with your vendors to ensure they understand this contractual arrangement to submit the requested records on your behalf without delay or request for payment. If there is anything we can do to make this process easier for you, please let us know. 

Simply log in to NaviNet, perform a Claim Status Search, and look for the “Investigate” button at the top of your Claim Status Results page. For more information on the NaviNet Claim Investigation process, please visit: NaviNet:Quick Access.

If Customer Service was not successful in resolving your question/issue, you may contact ProviderExecs@NebraskaBlue.com. Please include your Claim Investigation inquiry or call reference number with a summary of your concern.

Federal Employee Plan (FEP) claims: The Claim Inquiry form was decommissioned on March 1, 2024. If your FEP claim is not available on NaviNet, please contact our FEP CSC Team for assistance at 402-390-1879 or 800-223-5584.

BCBSNE is making changes to the way our EAPG edits occur. When we initially implemented EAPGs, we realized with your input, there were unforeseen impacts by having NCCI edits coupled with EAPG edits that had NCCI built in. These were managed through different systems but had downstream impacts to the claims pricing.

We've acted over the past two years to make sure this is no longer occurring and have fixed our system edits. NCCI edits in addition to the EAPG edits are now appropriately pricing claims without the need for manual intervention.

On Jan. 1, 2024, the University of Nebraska employees and their dependents joined BCBSNE for their medical and/or dental coverage. These members have the prefix UNE, or YZL if their only coverage is dental. To prevent unnecessary delays in processing your claims, please ensure the date of service is on or after Jan. 1, 2024.  

Please see policy number DP-X-004 if you need guidance in submitting orthodontic claims.

 
 

Effective July 1, 2024, ASC Facilities will follow the same procedure as professional claims for Unlisted CPT/HCPC codes.  See policy number RP-X-008 for complete details. 

 
 
Are you planning on transitioning your clearing house? BCBSNE is here to support your change. Selecting one that is already set up with BCBSNE will make it easier.


Please fill out the Electronic Remittance Advice Form available here: Find A Form and email completed forms to HealthNetworkRequests@NebraskaBlue.com. With the current situation we will be expediting all requests received. Once the form is received the process can take 2-5 days.

The following list isn't all inclusive, but it does give you an idea of who we are currently using. 

  • Ability
  • AdvancedMD, Inc.
  • Allscripts Payerpath
  • Apex EDI
  • Associated Billing & Consulting
  • Availity LLC
  • CareTracker INC
  • CLAIM.MD
  • Cortex EDI Inc.
  • EDI Health Group / Dental Xchange
  • Eligible, Inc.
  • eProvider Solutions
  • eSolutions Inc.
  • Experian Health
  • Healthcare IP (Oliveai)
  • Infinedi, LLC
  • Office Ally, Inc
  • Phicure Next LLC
  • Quadax Inc.
  • RBS of Rowan, LLC
  • Rycan Technologies/Trubridge
  • The SSI Group
  • TKSoftware, Inc.
  • Trizetto Provider Solutions
  • ViaTrack Systems (Nextgen)
  • VVC Holding Corporation
  • Waystar
  • Zotec Partners LLC

For a complete list of trading partners please reach out to your provider relations representative or email ProviderExecs@NebraskaBlue.com.

For assistance on obtaining your previous 835s to your new trading partner please email ProviderServicesOperationsSupport@NebraskaBlue.com.

ProviderPortalAuthQuestions@NebraskaBlue.com email is no longer available.  Please see our eLearning video, NaviNet Preauthorization, for guidance in submitting and viewing preauthorization and precertification requests.  For additional tips and resources, please see our Preauthorization page.

 

As stated in our December 2023 Provider Bulletin BCBSNE will begin using the (Council for Affordable Quality Healthcare) CAQH directory solution, called DirectAssure. By submitting your updates in CAQH, you do not need to complete and email the BCBSNE Provider Add/Extend/Transfer, Change of Address and NPI forms for the 14 updates outlined in the article, Streamlining the Process for Provider Directory Updates.

For your convenience a link is available from our Providers page at Nebraska Blue to submit updates to CAQH.

Effective April 1, 2024, BCBSNE will no longer make updates from the forms. Changes must be submitted and attested to in CAQH. Attesting to your information replaces the requirement to review your provider directory information every 90-days in NaviNet.  

Please review our December 2023 Provider Bulletin for complete details and watch for upcoming issues of our Update Newsletter and Provider Bulletin for updates to this process.

DirectAssure is a provider directory solution that works with the Council for Affordable Quality Healthcare (CAQH) Provider Data Portal. ©2023 CAQH

Blue Cross and Blue Shield of Nebraska utilizes InterQual criteria for hospital inpatient admission reviews, and hospitals can submit precertification requests for admissions via our online portal by signing into NaviNet. Currently, acute inpatient admissions that meet InterQual criteria and do not pend for a BCBSNE nurse to review, receive an automatic approval of four days for the initial admission. 

Effective June 1, 2024, the initial length of stay automatically approved for acute inpatient admissions will be reduced from four days to three days. If additional days are needed, a concurrent review request is submitted via the online portal as it is today. The number of days automatically approved for observation admissions or concurrent reviews that meet the appropriate InterQual criteria will not change.

As we announced on Dec. 29, 2023, new enhanced denial messages are available in NaviNet. This new information is intended to save your office time when checking on claim status and avoid the need to contact Customer Service or claim investigations.

In NaviNet, after performing a Claim Status Search, specific denial messages will be shown for each denied claim line in Claim Status Details. Denial messages corresponding to the claim line number will be displayed directly above the Claim and Service Line Details. 

Our new Enhanced Claim Denials video is available in our Provider Academy eLearning library.

The enhanced messages will provide information needed to determine next steps on the claim denial and avoid the need to reach out to Customer Service. If you are unable to resolve your claim denial question, please refer to your billing/coding team before reaching out to Customer Service for assistance.  

Implemented on Feb. 6, 2024:

  • Inclusive/Included Denials: Claims denied inclusive will reference the claim number and CPT code the claim line denied inclusive to. Keep in mind, not all inclusive or included denials deny inclusive to another claim or CPT code. An example is non-billable charges. In this scenario, a message will still display advising the claim line denied inclusive, but it will not reference another claim or CPT code.
  • Duplicate Denials: NaviNet will advise what claim(s) the claim is denying as duplicate to. Keep in mind, if claim C denies duplicate to claim B, and claim B denies duplicate to claim A, claim C is going to show the claim # for claim B - not for the original claim A.
    • Exception: Non-Nebraska duplicate denials, as those are determined by the member’s plan.

Implemented on Feb. 13, 2024:

  • Reduction in payment denial: NaviNet will show when a payment reduction has been made and the claim number/CPT code to reference when a payment reduction has been made. BCBSNE expects providers to self-service when questioning why the full allowed amount was not used during claim’s processing rather than opening a claims investigation.

Effective Jan. 1, 2024, we will no longer return the incorrectly filed requests. You will be responsible for correctly submitting the COB, workers’ compensation and subrogation adjustments.

Ensure you are using the reconsideration form for coordination of benefits (COB), workers’ compensation and subrogation adjustments instead of a timely filing override request.

If you are notified by another carrier that a member’s Blue Cross and Blue Shield (BCBS) insurance is primary, you should submit a reconsideration form with the primary recoupment or denial. Do not send a timely filing override request; it will not be returned and could impact claim processing.

If a provider obtained a prior authorization or retro authorization from the non-Nebraska Blues plan, but the claim has been denied as a Provider Sanction, please be advised:

  • Provider must submit a reconsideration via NaviNet
  • BCBSNE will send the reconsideration to the member’s plan for review
  • The member’s plan will determine if the claim will be reprocessed or if the denial is upheld
      

Newly enrolled members will have access to a digital temporary ID card in their myNebraskaBlue account. This ID card will only show the member ID number.

To verify benefits and eligibility, please log in to NaviNet or call our automated voice system at 800-635-0579.

ID Numbers for New Members
  

Blue Cross and Blue Shield of Nebraska (BCBSNE) requires a refund offsetting process for in-network providers. If you identify a claim overpayment has been made, please follow the claims adjustment process.

Please do not send a check/payment as the recoupment will be satisfied with a refund offset.

Please reach out to our Refunds Department at 800-562-3381 with any questions.

Note: If the offset is due to an overpayment of a Federal Employee Program (FEP) claim, offsetting will only occur on other FEP claims. We will not offset overpayments on FEP claims with claims that are non-FEP.

Read the Refund Offsetting (GP-X-095) policy.