Happening Now

Blue Cross and Blue Shield of Nebraska (BCBSNE), strives to notify our providers of new self-service technology and resources to assist in your day to day. Did you know that the U.S. Preventive Services Task Force (Task Force) has a free app called Prevention TaskForce? This app can help healthcare professionals identify which screenings, counseling interventions, and preventive medications are right for their patients. It includes all current Task Force recommendations and can be searched by specific patient characteristics, such as age, sex/gender, and selected behavioral risk factors. Download the app, on mobile or desktop, to find the preventive services that can help keep your patients healthy.

For more information and to download the app, click here.

Effective July 19, 2024, BCBSNE is not required to reimburse Medicare Supplement suppliers or beneficiaries for any durable medical equipment purchases greater than 115% of the Medicare-approved amount. Before receiving services, we encourage members to ask if their provider accepts Medicare or Medicare Assignment. If they do not, members may incur higher out-of-pocket costs.

For more information on this new State Mandate please refer to the Legislative Updates on our Provider Resources page.

The last provider directory file available in NaviNet^® will be August 5th, 2024. To ensure your information remains accurate and up to date, BCBSNE in-network providers are required to verify demographic data every 90 days and attest to your information through your CAQH portal.

For further information on utilizing CAQH please review our Provider Academy.

Effective May 1, 2024, BCBSNE will not extend agreements to credentialed providers with out-of-state tax IDs. Providers with locations in both Nebraska and a contiguous county state using the same tax ID will be permitted to add a location outside the state of Nebraska.

Providers who have delegated credentialing are not impacted by this rule.

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. 

The Department of Corrections has made a change to their member benefits that impacts the way claims are processed. Beginning Jan. 1, 2024, members whose ID numbers begin with 888 and are IP longer than 24 hours, could qualify for Medicaid.

If the member does qualify for Medicaid, the Department of Correction will inform the provider of the Medicaid coverage. Claims submitted to BCBSNE for these members will deny to provider liability.

These claims will not be eligible for appeal or reconsideration. There is no need to contact Customer Service or your Provider Executive. Please direct questions about these denials to the Department of Corrections or Medicaid for eligibility information if needed.

Department of Corrections Claims FAQs

Q: Why does the Department of Corrections member still show as active in NaviNet when inpatient claims are to be sent to Medicaid if the member has qualified for Medicaid?

A: As only inpatient hospital and inpatient professional claims should be sent to Medicaid when the Department of Corrections member has qualified for Medicaid, these members still have benefits for outpatient services through BCBSNE. Outpatient service claims for Department of Corrections members should be sent to BCBSNE.

Q: Does NaviNet provide detail on when inpatient claims for a Department of Corrections member should be sent to Medicaid?

A: If a member's inpatient hospital and inpatient professional claims should be sent to Medicaid, NaviNet Eligibility and Benefits and category "Hospital - Inpatient" will show "Not Covered". Claims should be sent to Medicaid.

BCBSNE has made the business decision to not cover Q0224 & M0224. While these drugs had received emergency use authorization, these drugs are not FDA approved.  Additionally, any drug or service that is not FDA approved will be denied by BCBSNE as benefit plans do not provide coverage. Claims submitted would deny as provider liability. 

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.

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. 

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.