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 »

Please continue to watch Happening Now for updates. 

Updated Timely Filing Override Request Form

Updated June 17, 2021

An updated version of the Timely Filing Override Form has been added to https://www.nebraskablue.com/Providers/Find-a-Form. Please use this form to submit future requests for Timely Filing denial reviews, along with supporting documentation, to ensure prompt and thorough review. Incorrect forms will be returned. Additional information can be located in the Policy and Procedure General Manual available https://www.nebraskablue.com/Providers/Policies-and-Procedures.


The Modifier-CS represents Cost Share Waiver for COVID-19. This requires insurers and health plans to waive the cost-share (deductible, coinsurance and/or copay) for individual for certain COVID-19 testing and the related services to the testing.  
 
The CS Modifier should only be used on COVID-19 testing-related services, which are medical visits that:

  1. Are between March 18, 2020 through the end of the Public Health Emergency; 
  2. Result in an order for or administration of a COVID-19 test; 
  3. Are related to furnishing or administering such a test or to the evaluation of an individual for purposes of determining the need for such a test; AND
  4. Are included in the following categories of HCPCS evaluation and management codes:
    • Office and other outpatient services
    • Hospital observation services
    • Emergency department services
    • Nursing facility services
    • Domiciliary, rest home or custodial care services
    • Home services
    • Online digital evaluation and management services

The CS modifier should only be placed on the evaluation and management codes and testing done to diagnose COVID-19. It should not be used on codes tied to other services to treat or prevent COVID-19.

Want to know the status of a submitted claim? You now have access to Claim Status in NaviNet! You will need to set up a log-in with NaviNet; they can be reached directly at 1-888-482-8057.

Today we are announcing a change to the way we process claims with medically unlikely number of units (MUE – Medically Unlikely Edit). Through our interactions with you and internal review, BCBSNE recognizes this was a barrier to the ease of doing business with us.

Thank you for your partnership as work together with improving the process. If you should have any questions, please reach out to your PE.

This change will be effective beginning June 15 for BCBSNE, non-Nebraska and FEP In Network (INN) claims.

FEP Out of Network (OON) claims will continue to return.  However, this volume is so low, we did not want to miss an opportunity to begin this new process. 

Claims received prior to June 15 but not processed until June 15 will be included.

Previous Process:

  • Claims stop for manual review to validate number of units
  • If medically unlikely units and/or missing medical records – entire claim is returned 

New Process: 

  • Claims will have a review to validate number of units
  • If validation confirms medically unlikely number of units and medical records are not included, appropriate message code will be applied (per LOB) and the claim will deny just the MUE lines
  • Other line items (if any) on the claim will process if errors are not present 
  • If claims are denied for MUE, providers can resubmit claims with corrected units or submit reconsiderations as appropriate 

LOB Message Codes: 
LOCAL & non-Nebraska claims

EOP codes

  • PC12 – Provider exceeded the maximum number of billable units for these services per day
  • PC 14 (non-Nebraska OON claims) – Number of units submitted exceeds maximum allowed for this service. Please contact the out of network provider to resubmit claim with appropriate units or additional medical justification.

835 codes 

  • CARC 222 – Exceeds maximum contracted number of hours/days/units by this provider for this period. This is not patient specific.
  • RARC N640 – Exceeds numbers/frequency approved/allowed within time period

FEP INN claims

EOP code

  • 482

835 code

  • CARC 252 – An attachment/other document is required to adjudicate this claim/service

COVID-19 vaccine administration claims processed prior to March 9, 2021 may have applied member cost share in error.  These claims are being reviewed for adjustments; nothing is needed from the provider. 

Please do not submit reconsiderations on these claims, this could delay or contribute to further processing issues.

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. 

BCBSNE Response to LB997
Out-of-network providers in Nebraska may no longer balance bill patients for medical care received from facilities in emergency situations. The recently-passed Legislative Bill 997 (LB997) also known as the Out-of-Network Emergency Medical Care Act, keeps consumers from receiving surprise bills from out-of-network providers or facilities for medical emergencies.

Out-of-network providers will receive remits for these claims. Remits will display the M16 RARC message code which communicates the information below. 

M16 Alert

Providers disputing the payment from BCBSNE may complete an LB997 - Out of Network Emergency Medical Care Act Reimbursement Dispute Request. 

Download the Dispute Request form »

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

Non-Nebraska 835s Now Available on NaviNet
Great news! BCBSNE has completed the work which enables non-Nebraska 835s to now be available on NaviNet

Previously, providers would contact our EDI team inquiring about missing 835s in NaviNet, the vast majority was due to 835s only being sent to the members plan. 

Beginning with 835s sent out this week, a copy of each 835 was also sent NaviNet.

In 2019, certain vaccine codes began requiring NDC numbers for pricing. The NDC number allows BCBSNE to provide better reimbursement for providers.

In July 2020, additional vaccine codes in the 90281-90749 range were added to this requirement.

Claims that are returned for needing an NDC number will need to be resubmitted with the appropriate NDC number.

NOTE: Admin codes of 90460, 90461 and 90471-90474 do not require an NDC number.

Blue Cross and Blue Shield of Nebraska continues to work on improving the tools available to our providers. The following can now be obtained for non-Nebraska BCBS members:

  • Accurate claim status 
  • Correct claim ID
  • Applicable check number/EFT with working remit link

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 display 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. See the Provider Level Adjustments for more information »
  • 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
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 »

For all inpatient* and professional claims that occur at the end of one year and continue into the next year, charges incurred during each year must be submitted on separate claims. 

This requirement takes effect with claims that span from 2020-2021.

For example:

If dates of service are from 12/15/2020 to 1/15/2021:

  • Submit charges incurred from 12/15/2020 – 12/31/2020 on one claim
  • Submit charges incurred from 1/1/2021 – 1/15/2021 on a separate claim

Claims that are submitted with charges incurred during both years on the same claim will result in processing delays. 

Split billing of charges that span from one year to the next is highly recommended.  Claims that are split could result in auto-adjudication and/or faster processing times.

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

BCBSNE will accept claims with an observation line item greater than 48 hours to allow for accurate documentation; however, charges in excess of 48 hours will be denied as content.

Example
  • 52 hours OBS submitted (on one line)
  • 48 hours paid
  • 4 hours were included as content

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

Please find up-to-date timelines on BCBSNE's NaviNet home page.

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 »

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.

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.

Provider Resources

Healthy Blue

Healthy Blue Landing page: Home | NE Provider - Healthy Blue
Healthy Blue Customer Service: 833-388-1405 (TTY 711); Hours of Operation: Monday — Friday, 8 a.m. to 5 p.m. CT.
Provider Bulletin: October 2020

Centers for Medicare and Medicaid Services

Place of Service Codes
CMS ABN

Nebraska Medical Association (NMA)

The NMA is excited to announce the launch of their peer-to-peer physician coaching program LifeBridge Nebraska.

To learn more and to view coach profiles, please visit nebmed.org/lifebridge.

Coding and Billing

The resources shared in this section are for informational purposes only and are not binding to the reimbursement of BCBSNE claims. If you have questions regarding BCBSNE’s billing or reimbursement policies, please consult the BCBSNE Provider Policies and Procedures Manuals or contact your provider executive.