Happening Now

For ease of access, we have created a COVID-19 page which will be your source for updates during this pandemic. View COVID-19 updates »

Retroactive changes
Due to the ever-changing status of COVID-19, BCBSNE will research and make retroactive changes to claims on your behalf as we adjust our policies.

Claims Processing Delay

Updated July 13, 2020

BCBSNE is experiencing a system outage that is impacting the processing of claims. Providers can still file claims and should receive their CCRs on July 14, 2020.

As of Monday, July 13, 2020, we plan to resume claims processing the morning of Tuesday, July 14, 2020. We do not expect a delay in the July 14, 2020, payment cycle. However, if we find there will be an impact, we will communicate that information on Happening Now.

Bilateral Surgery Claims

Updated July 10, 2020

BCBSNE has identified an issue with the new bilateral surgical claims process.  We have a solution to correct this and it is scheduled to be implemented mid-September.

To avoid delay in processing, all bilateral surgery claims will be manually reviewed and processed.  Once the automated fix is complete, we will conduct an internal audit to validate accurate payments were made.  If any discrepancies are found from the audit, we will reprocess those claims to apply correct pricing.  We apologize for the inconvenience this causes.

Please continue to watch Happening Now as well as the weekly emails from your Provider Executive for updates.  

Claim Submission Responses (EDI)

Updated July 10, 2020

We are pleased to report that claims that were originally rejected with the error messages below are in process. Specific details can be found below. Your patience and understanding as we worked to clear up these errors have been greatly appreciated.

Corrected Claims for NON-Nebraska Members

Rejection Message: EDI HRP Claim Source Must Match for Replacement
As of July 10, 2020, claims for NON-Nebraska members that were originally rejected due to the above error are beginning to be processed. Please allow additional time for these claims to be processed.

Type II provider NPI Claims for all Members

Rejection Message: EDI HRP Claim Source Must Match for Replacement
This rejection was corrected the end of June 2020. BCBSNE has begun processing claims that were rejected with the above error. Providers will not need to resubmit claims as was originally communicated.

Please continue to watch Happening Now for updates specific to these identified EDI responses.

OA 16/CO 16 Remark Codes – New 835s coming!

Updated July 10, 2020

We have been working on identifying the gaps in our solution to this issue.

What was impacted?

This issue impacted non-Nebraska member remits/835s with dates of service beginning Jan. 1, 2020, that were processed prior to June 23, 2020.

When will these remits/835s be reprocessed?

Beginning the week of June 8, 2020, previous 835s that included an OA 16 or CO 16 remark code on a non-Nebraska member remit/835 began to be reprocessed. However, we did identify gaps in our solution to this issue:

  • On June 24, 2020, we found the deployment corrected all but 39 claims.
  • In addition, we found most of the errors were due to a missed step when we unsuppressed the message codes.
  • We anticipate our fix will be fully implemented soon.

Your office should begin to receive reprocessed 835s over the next few weeks. Continue to watch Happening Now and/or weekly Provider Executive Friday emails for more information. Please do not reach out prior to mid-July as information will not be available.

Medical Claim Status Questions & Backlog Updates

Updated April 30, 2020

As more cases of COVID-19 develop, we are prioritizing calls to Customer Service to better serve you, our providers, and our members. We will be focusing on calls related to processed claims, preauthorizations and appeals. If you are calling about claim status, please utilize the IVR or Navinet until further notice.

Furthermore, in order to lessen the hold times and be available for our members, we will only take 10 member IDs instead of the current 20. Thank you for your understanding during these uncertain times. 

Customer Service continues to take the following claim questions calls from medical providers:
  • Adjustments
  • Appeals
  • Reconsiderations
  • Refunds
  • Returned claims

We understand checking claim status is time consuming. We also acknowledge we have a backlog that we are working to reduce. Please check  NaviNet's BCBSNE page for more detailed information regarding claim processing timelines.

Please continue to watch Happening Now, NaviNet and our provider newsletter for future communications.  

Medicare Supplement CO 45 Remark Code

Updated April 24, 2020

Currently providers are receiving CO 45 (charges exceed contracted arrangement) remark code on remits. This is not a separate discount. Providers can ignore this code as they would receive the correct adjustment amounts from Medicare.

Corrected Claim Submission

Updated April 23, 2020

When a corrected claim is submitted, please do not add a suffix “00” to the end of the claim number. Our new system, HealthRules, rejects any claim numbers longer than 14 positions. Adding a suffix to the claim number results in 16 positions.

ASC - Modifier SG

Updated Apr. 15, 2020

ASC - Modifier SG
Beginning April 15, 2020, all ASCs must append modifier SG to the claim form (HCFA 1500) for proper payment of facility claim(s). Claims processed prior to April 15, 2020, will be adjusted.

Locating EFTs/Checks on NaviNet

Updated Mar. 20, 2020

NaviNet has two dropdowns:
  • Billing Provider, which is required
  • Servicing Provider, which is optional

To see all EFTs/Check associated with the billing provider, do not select an option on the Servicing Provider dropdown.  

EFT drop down

Taxonomy Required on All Claims

Updated Mar. 13, 2020

BCBSNE introduced the requirement for taxonomy codes on electronic claims in 2019. Our May UPDATE provided additional information. Beginning March 16, 2020, we will require both electronic and paper claims to be submitted with the taxonomy code.

Currently, our system is rejecting electronic claims missing the taxonomy code, but we have been processing paper claims. Beginning Monday, March 16, 2020, we will also return paper claims. Making this change will allow us to process claims more efficiently.

For additional information, please see Claims FAQs »

Remit/EOP Timing

Updated Jan. 8, 2019

Previously, remits and EOPs were received simultaneously with payments. In our new system, HealthRules, this will not always be the case. Typically, remits will be received within 72 hours from the time of the weekly payment. Reminder, remittance information is available via NaviNet. If you are unable to retrieve your remittance advice after 72 hours, please check NaviNet and your clearinghouse, if applicable.  

If you are unable to locate remits after using the steps above, please email your request to ProviderServicesOperationsSupport@nebraskablue.com. Our teams will research and follow-up within 10 business days.

Please include:
  • Provider name, NPI, Tax ID
  • Details on the payment
    • Check number (if applicable)
    • Check amount (if applicable)
  • Date missing
  • Contact information

Corrected Claims

Updated Dec. 13, 2019

When a corrected claim is submitted, the billed amount for the corrected claims will be the same as the original billed amount on the remits and EOBs. BCBSNE will correct the claim as submitted by the provider, this will reflect in the allowed amount and the paid amount. The billed amount will always reflect the original claim amount.

Dental EOP Message Codes

Updated Oct. 17, 2019

For the Explanation of Payments (EOPs) that have multiple pages, it is possible the message code description is missing.
Download code descriptions »
Download FEP code descriptions »

**Some codes have multiple descriptions, please review the EOP in question and determine what description is most applicable for the code in question.

270/271 Transactions

Updated Oct. 08, 2019

Until further notice, all 271 transactions will return the alpha prefix that is submitted on the 270 transactions. Please reference the member ID card for the current alpha prefix to be used for claims submissions.

Recoupment

Updated May 31, 2019

You will notice changes to the recoupment initiation notifications and recoupment offsets displayed in your 835s and EOPs. Changes include the following:

Changes to 835 and EOP:
  • Recoupment offsets will be reflected immediately
  • Recoupment offsets will not happen for a minimum of 30 days after notification
  • When money is deducted from a future payment; it will be important to reference the previous 835/EOP for details
  • Once a claim has been adjusted/voided, the adjustment/void and the offsetting of the recoupment will be reflected in the next 835 and/or EOP
New for HealthRules:
  • FEP claims will offset immediately
  • Partial recoupments
  • dental recoupments
  • Payment Impact = True
    • The financial impact is realized on this RA
  • Payment Impact = False
    • The financial impact is realized on future RA
  • Reversals will no longer be seen on the recoupment claim run since this was communicated when the recoupment was initiated
  • The received payment amount will only reflect in the 835 when claims have been adjusted and the payment is applied to the receivable within the same payment cycle.
  • On the paper remit (EOP) when recoupment is offset against from a subsequent payment run you will see a recoupment amount listed next to the corresponding claim number as well as the total recoupments and the net payment
  • When the receivable is reported on the current payment is recouped against itself in the same payment, the final claim will include an extract message representing the change in payment amount but not recoupment details
Adjustments/Voids:
  • The claim being voided will reflect as a reversal of the original 835 that was generated for that claim payment
  • That void will appear as the exact opposite of the original 835
    • Each line amount and the count will be shown with the opposite amounts (positives will become negatives and negatives will become positives)
    • Since there will be no net change in the check payment, the net reversal to the paid amount will also be reflected in a check level Provider Adjustment (PLB) segment with a qualifier of Forwarding Balance (FB) for a negative adjustment
Guide to Understanding the Adjustments
Notes include:
  • Where to find the adjustments on the claim
  • An example of the new change where positives become negatives and negatives become positives
  • How to tell if the adjustment affects the claim
  • An example of a message indicating the amount retracted from the adjusted claim

Questions? Reach out to your Provider Executive Team »