We wanted to advise our providers claims with NDC (National Drug Code) errors for non-Nebraska members are being returned.

Non-Nebraska claims with NDC errors will be returned for missing, invalid or incorrect NDC.  The process for BCBSNE and FEP in network (INN) claims will not change, these will continue to receive a line-item denial if the NDC is missing, invalid or incorrect.

Process for BCBSNE and FEP INN claims: 

• Specific NDC line item will deny if missing, invalid, incorrect, etc. with message code 
  • Denial message code PC 33 (for provider) – The National Drug Code (NDC) is missing or invalid
  • RARC code will be M119 Missing/incomplete/invalid/deactivated/withdrawn National Drug Code (NDC)
  • CARC code will be PR or CO 16 dependent on if provider is PAR or non-Par
• Other line items (if any) on the claim will process if errors are not present 
• If claims are denied for NDC, providers can resubmit claims with corrected NDC or submit reconsiderations as appropriate 

We are continuing to review this process and will advise as we learn more. Please continue to watch Happening Now. 

BCBSNE is aware of the Norditropin shortages in the market. Our response to this situation is below.

Effective immediately, our preferred products will be Norditropin and Genotropin. Our formulary and medical policy will include another growth hormone product. 

Genotropin provides another clinically appropriate growth hormone therapy option. 

BCBSNE is actively mitigating the need for another preauthorization submission to use Genotropin. Updating the overrides in our system may take a couple days, but we are working to have these updated quickly. Currently, we do not need another request from providers to use Genotropin. 

We will update this page once we have finalized our updates and advise if anything changes. 

On September 6, 2022, BCBSNE advised all providers of the below information. It is imperative to be aware of the January 31, 2023, deadline that is quickly approaching, your attention to this matter is appreciated.

To become a contracting BCBSNE provider all applicants must complete the credentialing process and have a signed agreement on file, prior to be accepted into the network. New practitioners wishing to join BCBSNE can complete the CAQH application at CAQH.org. For more information regarding credentialing requirements and/or to request a provider agreement, please visit NebraskaBlue.com/Providers/Credentialing. 

Effective November 6, 2022, BCBSNE requires all providers that are not sole proprietors to have a Type 2 NPI, or for sole proprietors to indicate as such on NPPES. This is required to align with Blue Cross Blue Shield Association standards. 

Options For NPI Registry:

• If you are the only provider practicing at your location, please make sure that NPPES is updated to reflect your individual NPI as “Sole Proprietor”. 
• If you are the only provider practicing at your location, but eventually want to expand, please apply for a Type 2 (Organizational NPI) for your location/group to bill under.
• If you have multiple practitioners practicing at your location, regardless of how often, you must apply for a Type 2 (Organizational NPI) for your location/group to bill under.

How to Update NPPES:

• Go to https://nppes.cms.hhs.gov/ to apply or update existing information.
• More information on NPI found at:
  • NPPES FAQs — NPPES Documentation (hhs.gov)
  • NPI: What You Need to Know (cms.gov)      

How to Update Record with BCBSNE:

• Send an email to HealthNetworkRequests@NebraskaBlue.com to indicate which option you have chosen for your NPI (If you are an existing provider that needs to update records).

Effective January 31, 2023- Any provider that has not updated their records will be subject to contract termination. Any new providers coming in are required to follow the same guidelines.

Moving forward, please ensure you are keeping all your data current in NPPES. The Blue Cross Blue Shield Association does verify all BCBSNE provider data against NPPES to confirm taxonomy and NPI information is valid and accurate. 

BCBSNE has established access and availability standards to ensure timely services are available to all members. These standards have been recently updated to comply with regulatory requirements and are periodically measured through member satisfaction surveys, member complaint analysis, and access and availability surveys. 

In-network providers are required to ensure the availability of appointments in accordance with the standards. For more information on Appointment Availability/Access standards, go to Credentialing Information for Providers.

Effective Jan. 1, 2023, member contracts have been updated to note this change:

Non-covered services include:
Dietary counseling, except as part of nutritional management for diabetes, certain conditions covered under ACA Preventive Services and eating disorder.

Our system reconfiguration has been validated, claims will no longer deny without the QW modifier effective on claims received October 21 and after.  

QW modifier will no longer be required on CLIA-waived lab tests. Claims that have denied due to missing this modifier should not be resubmitted, this could result in the claims being considered duplicate claims.  Instead, a report will be run to capture all claims impacted.  BCBSNE will auto-adjust all line items that denied due to the QW modifier.  

A report will identify claims denied from Sept. 1 – Oct. 21 to and those claims will be adjusted.  Please understand those claims will be adjusted and we ask you NOT to resubmit. 

Blue Cross and Blue Shield of Nebraska has decided to align with CMS’s MPPR guidelines and apply the MPPR for therapy and radiology procedures.  These changes will take place December 1, 2022.

Non-Nebraska Outpatient and Professional Claims

For outpatient and professional claims with charges incurred during different years, must be submitted on separate claims. This requirement will be the same each year end for split year claims.

Claims for non-Nebraska members that are not split will reject back to the provider upon submission.

For example:                                                                                                                                                                            
If dates of service are from 12/15/2022 to 1/15/2023:

• Submit charges incurred from 12/15/2022 – 12/31/2022 on one claim
• Submit charges incurred from 1/1/2023 – 1/15/2023 on a separate claim

Claims that are submitted with charges incurred during both years on the same claim will be rejected back to the provider to split the claim. 

Institutional Inpatient Claims

For inpatient* institutional claims, it is no longer required to split the entire claim for non-Nebraska members, however, it will be required to split the R&B charges per calendar year.

Claims for non-Nebraska members where the R&B charges are not split per line by calendar year, will reject back to the provider upon submission.

For example:
If dates of service are from 12/15/2022 to 1/15/2023:

• Submit R&B line for 2022 dates of service on another line
• Submit R&B line for 2023 dates of service on another line

Claims that are submitted with the R&B on one line for multiple years, will be rejected back to the provider to split the R&B lines.

*Inpatient includes acute care hospital, psychiatric hospital, rehabilitation hospital, skilled nursing and swing-bed

In compliance with the Consolidated Appropriations Act of 2021, providers are required to review and update their information in our provider directory at least every 90 days.

• Beginning 10-1-22 ALL providers (including dentists) can begin to review directory info using NaviNet
• Providers NOT using NaviNet will need to sign up. Go to Connect.NaviNet.Net/Enroll to register. 
• More info is available in the July Update
  
   

The Consolidated Appropriations Act (CAA), effective January 1, 2022, contains a provision that requires online provider directory information be reviewed and updated (if needed) at least every 90 days. 

• In Q4 2022, we are implementing a new process using NaviNet, that will allow you to review your provider directory information to ensure we have the most current information available to our members.
• For those providers not enrolled in NaviNet, we strongly encourage you to register as soon as possible.
  • Go to https://connect.NaviNet.net/enroll to begin the registration process
  • All participating medical and dental providers can register for a NaviNet account
  • NaviNet is a secure self-service provider portal for verifying benefit and eligibility information, checking on claim status, and submitting prior authorizations

More information will be coming on the process of reviewing your directory information in NaviNet. Please continue to review your information regularly and let us know as soon as possible if any of your information has changed. 

If updates are needed, visit the Administrative Updates for Providers page for instructions and forms. We appreciate your help ensuring our members have the most up to date information. 

For PHO groups handling their own credentialing processes – only the below steps will apply:

• BCBSNE will be requesting submission of a full roster every 90-days
• Additional communications will be sent on the timeline for this request
• Your Provider Executive will be reaching out with more information

Beginning March 1, 2021 ANY corrected claims submitted with a recon will be returned. Corrected claims should be submitted electronically.

If they cannot be submitted electronically because your claim will include attachments, you must file your corrected paper claim to BCBSNE with the attachments, do not submit corrected claims using a reconsideration form, it will be returned.

More information can be found in section 8 of our General P&P. 

This is a reminder that remits will be received by the Clearinghouses 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

We have adjusted our process to ensure allowed amounts are reflected on the 835s.  Providers should see this change reflected on the 835s moving forward. 

We would like to bring awareness when BCBS is not the primary payer.  When BCBS is secondary, the allowed amount displayed on the 835 reflects what is allowed AFTER the primary insurer processes the claim.  Please see some examples below:

Example 1: 

• Primary allows $100 and pays $85 
• 835 will reflect $15 as the allowed amount ($100-$85 = $15)

Example 2: 

• Primary allows $100 and pays $0
• BCBSNE allows $120 but 835 will reflect $100 as allowed amount of primary

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.

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 »