Blue Cross and Blue Shield of Nebraska will be closed on Monday, Dec. 25 and Monday Jan. 1, in observance of Christmas and New Year's Day. Please use NaviNet for your eligibility, benefits, and claim status needs during this time.  

Please be sure 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.

Beginning 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.

Effective January 16, 2024, BCBSNE will begin using the (Council for Affordable Healthcare) CAQH directory solution, called DirectAssure. DirectAssure works with the CAQH Provider Data Portal, formerly known as CAQH ProView. 85% of in-network providers use CAQH today to submit their information and share it with multiple health plans. 

BCBSNE will automatically receive updates you submit in CAQH for the following items.

• First, middle, and last name
• Suffix
• Office telephone number and extension
• Fax number
• Primary email address
• Location adds and terminations
• Taxonomy
• Gender
• Date of birth
• Languages spoken
• Accepting new patients
• NPI
• Provider type
• Primary practice indicator

By submitting the update in CAQH, you do not need to complete and email the BCBSNE Provider Add/Extend/Transfer, Change of Address, or NPI form. Demographic changes will be updated in the provider directory within 48-hours from submission. Please allow up to 30 days for taxonomy, NPI and provider type changes.

Effective March 1, 2024, BCBSNE will no longer make updates from these forms. Changes must be submitted and attested to in CAQH. Using this process ensures the directory reflects the most current information for our members and improves claim processing accuracy. Attesting to your information in CAQH also replaces the requirement to review your provider directory information every 90-days in NaviNet.        

Please note there are no changes to the processes below. The appropriate instructions and forms can be found in NaviNet.

• Adding or updating EFT information
• Adding or updating ERA information
• Terminating all locations  
• Adding Provisional Providers
• Updating information for facilities/institutions

If you do not have a CAQH profile, please create one as soon as possible. For more information on creating a profile and using the CAQH Provider Data Portal please visit Proview.CAQH.org.

Delegations/PHOs handling their own credentialing should continue to follow their current processes, including sending a full roster file every 90-days. If providers covered under a delegation agreement have a CAQH profile and are attesting to their data for their location handled by the Delegation, BCBSNE will automatically receive and make updates for the 14 items listed above.

When patient care extends into the new year, following our Split-Year Claim Submission policy ensures your claims are not rejected, returned or delayed due to billing errors.

There is currently a known issue in NaviNet, regarding patients showing terminated in NaviNet when they aren’t actually termed. When searching for the member please enter their 2-digit member number suffix at the end of the ID number to access the member's eligibility information.

For example:

• The subscriber will always have a suffix of “00”
• The next person on the plan will have a suffix of “01”
• The third person on the plan, will have a suffix of “02”, so on and so forth.

When submitting Medicare Advantage claims, providers will need to ensure:

• Rendering NPI number is not populated in box 24J / 837 loop 2310B segment NM1 and/or 2420A segment NM1 - if the number is the same as the billing NPI
• If a provider is a sole proprietor – only submit the NPI in box 33A / 837 loop 2010AA segment NM1 - this is a situational rule and is not a requirement
• If a claim is submitted with the same NPI in both box 24J and 33A the claim will reject
• Submit claims with a street address in the billing address field
• Claims are not accepted with a PO Box in the billing address field

Any outstanding claims not submitted per above instructions will need to be resubmitted.

Host claims will return when the facility ZIP code is missing from Box 32
Medicare Advantage PPO paper claims (regardless of place of service) and Medicare Advantage PPO electronic claims (place of service 12) must be submitted with the service facility ZIP code in box 32.

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

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

Providers with patients/members having difficulty obtaining Norditropin and Genotropin provides another clinically appropriate growth hormone therapy option.

BCBSNE is actively mitigating the need for another preauthorization submission to use Omnitrope. Currently, we do not need another request from providers to use Omnitrope.

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

BCBSNE is aware of an issue with electronic claim submissions rejecting in error and is working to resolve as soon as possible.

This is occurring for the following situation:

• BCBSNE ID#'s
• Corrected claim or void claim submissions (7 or 8 in box 22 with the claim #)
• Submitted Oct. 6, 2023, to present

We will pull any claims forward that rejected in error, and you do not need to resubmit. Please allow up to 30 days for resolution. 

As BCBSNE communicated, starting November 1, 2023, providers are being directed to NaviNet^® for self-service for all member, preauthorization/precertification, claim, reconsideration, and appeal needs.

In the event information is not available on NaviNet:

1. Review our Happening Now to see if there is an already known issue
2. Missing Remittance Advise (RA), reach out to your clearinghouse for the information (as applicable)
   • If not available via your clearinghouse - email ProviderExecs@NebraskaBlue.com
   • Please include the payment number and payment amount
3. Receiving an error message or information is missing on NaviNet – contact CSC to report
   • Please include the EXACT message you received on NaviNet or explain what information is missing
4. Preauthorization request was not auto approved, and the appropriate criteria was submitted
   • Ensure your contact information (full name, phone and fax number) was included in the Notes section
   • Contact @Provider Portal Auth Questions
   • For urgent and immediate assistance, please call 800-247-1103, option 5
5. Unable to access claim on NaviNet and need to submit Appeal or Reconsideration
   • You may fill out the recon/appeal form completing the required fields
   • Fax the correct form to the number on the bottom of the form
   • You will not be able to track the status of this form online. Please allow 45-60 days for a response.
     *Preservice appeals are not part of this process
6. Emails or notes on forms indicating "Not available on NaviNet" with nothing to substantiate the issue will not be addressed. 

Effective January 1, 2024, Carelon will add the following new code to prior authorization. This is a new CPT code for 1/1/2024.

BCBSNE has sent certified letters and is currently calling providers who have not yet completed their accurate registration with NPPES. Not completing the steps for participation would result in termination from the network. Providers were again advised on Jan. 12, 2023, to update their NPPES status to sole proprietor or obtain a Type II NPI to avoid termination on or after Jan. 31, 2023.

If you have NOT completed the steps below – you are subject to termination.

How to Stay in Network:

• If you are a sole proprietor, log in to https://nppes.cms.hhs.gov/ and select: 
  • Option 1"YES" I am a sole proprietor. 
• If your clinic has multiple practitioners, update NPPES and select: 
  • Option 2 "YES" I will be getting a Type 2 NPI
  • Option 3 "NO" I prefer to go out-of-network
• Send an email to HealthNetworkRequests@NebraskaBlue.com to indicate which option you have chosen for your NPI.

Once a provider has notified us by sending the email to HealthNetworkRequests@NebraskaBlue.com we will update our system upon validation of the information on the NPPES site.

Any provider that has not updated their records will be fully terminated and claims will reject, return, deny or process out-of-network.

New providers joining the BCBSNE network are required to follow the same guidelines.

We are aware of an issue where spouse or dependents on a plan are not always giving results on NaviNet. We are working to resolve as soon as possible. In the meantime, please contact Customer Service at the number of the back on the member's ID card for your immediate eligibility and benefit needs.

Did you know if you submit claims with your patient account number this available in NaviNet?

This is not a BCBSNE assigned number—this is the number from your EMR/records. Our CSC team will no longer provide this information instead we will direct you to NaviNet or to reference your own system.

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.

As mandated by the Nebraska Department of Insurance, effective Sept. 1, 2023, all credentialed providers who are eligible to provide telehealth services (see policy GP-X-016, Telehealth) will be reimbursed at 100% of the in-person allowed amount. 
 
BEHAVIORAL HEALTH PROVIDERS: LB487 effective Sept. 1, 2021, mandated that in-network telehealth behavioral health services to be covered at 100% of the in-person allowable amounts.  Behavioral health services provided via telehealth will continue to be reimbursed at 100% of the in-person allowable amounts.
 
Providers exclusively delivering telehealth services must live in the state of Nebraska, be a member of a credentialed Nebraska-based PHO or employed by a licensed or credentialed facility in Nebraska. Providers will also still need to meet the credentialing criteria that is available at Credentialing Information for Providers.

BCBSNE Member ID cards are available on NaviNet. Providers requesting timely filing overrides for member ID will be required to show system notes proving the member presented without insurance and/or a different insurance. Per policy GP-X-046 for an exception to be considered, we must receive proof of no member insurance at the time of service or proof that attempts were made to obtain insurance and/or payment.

In addition, if a member provides insurance other than BCBS insurance and you receive notification from that insurance the BCBS is primary, this is considered a COB situation and should be submitted on a reconsideration with the primary recoupment or denial. Do not send as a timely filing because these are being returned to you and delaying your ability to have the claim processed correctly.

Starting on May 24th and every Wednesday going forward, Blue Cross and Blue Shield of Nebraska Customer service will be closed from 9:00am to 10:30am central time for an all-department meeting. This time will be used for Learning and Development for our employees to ensure we continue to deliver the best service possible. Thank you for your understanding.

As a reminder – Self Service Tools are available for use:

• NaviNet^® is available by clicking here NaviNet.Navimedix.com/Plan-Central/BCBSNebraska#/
  •  Member eligibility details are based on the date entered as the service date. Coverage will show as inactive if the date of service is prior to the effective date.
• Claim status inquiries and processing details are also available on Navinet. 
  • If you need additional assistance with claim status inquires you may use our new Claims Investigation feature. Please allow up to 5 days for our response.
• The automated voice system is available via 1-800-635-0579. 

_{NaviNet is a healthcare provider portal providing services for Blue Cross and Blue Shield of Nebraska.}

 At BCBSNE, we are working to help our members with complex medical conditions get the care they need in the most cost-effective way.
 
The biologic medication Humira® (adalimumab) will begin to have multiple cost-effective biosimilar alternatives available starting in July 2023. Biosimilar products can be utilized in most clinical circumstances as the reference product.
 
Starting Jul. 1, 2023, we are adding the biosimilar products AmjevitaTM (adalimumab-atto)* and Cyltezo® (adalimumab-adbm) to our preferred product list. This means that BCBSNE will have coverage, if medical policy criteria is met, for two biosimilars in addition to the reference product. For reference, Cyltezo is an FDA approved interchangeable product to some Humira products.
 
For questions regarding coverage of adalimumab reference and biosimilar products, please refer BCBSNE members to call the Member Services department at the number on the back of their member ID card.
 
*NDCs starting with 55513 

On May 25, 2023, BCBSNE implemented a change in our mail processing.  This change impacts the time it will take for providers not signed up for EFTS and ERAs to receive paper check payments and paper remits.

Previous Process:

• Checks and remits were received within 3-5 business days

New Process:

• Checks and remits will be received within 5-7 business days

As we continue to enhance our digital delivery channels, paper transactions will decrease.  To get ahead of future transitions and avoid the extended time it will take to receive the check and remit, providers can sign up for EFTs and ERAs by completing the forms found on NaviNet and submitting to HealthNetworkRequests@NebraskaBlue.com.

• Electronic Funds Transfer (EFT)
• Electronic Remittance Advice (ERA)

If you have questions, please contact your Provider Executive. 

Effective May 15, all forms used to update demographic and practice data will only be available only through NaviNet via the Administrative Updates/Secure Forms. This includes the forms to update EFT information. You can access the forms under the Resources section. 

• NPI Notification
• Electronic Funds Transfer Enrollment Request 
• Provisional Provider Form 
• Extend-Transfer Existing Agreements
• Change of Address Form 

If you do not have a NaviNet account, please visit https://connect.NaviNet.net/enroll to begin the registration process. All participating BCBSNE health care and dental providers can enroll for access. 

BCBSNE is committed to ensuring claims and adjustments are handled as timely as possible. To create a more efficient handling of COB, Worker’s Compensation and Subrogation adjustments, we are removing these as options from the timely filing form beginning May 15. Providers should use the reconsideration form found on Find a Form for Providers and submit via NaviNet or follow the steps on the bottom of the reconsideration form. 

If you do not have a NaviNet account, please visit https://connect.NaviNet.net/enroll to begin the registration process. All participating BCBSNE health care and dental providers can enroll for access.

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 »