Exciting updates to the NaviNet® registration process!
NantHealth (NH) is thrilled to announce the enhancements to the NaviNet registration process are now live and designed to streamline your experience, enhance security and eliminate previous frustrations.
Here’s what you can expect:
Simplified validation steps: Providers will now complete an “about me” quiz and submit a single business document. Successful completion can lead to registration approval within 24 to 48 hours.
No initial phone calls: If you pass validation, no phone call is needed. If additional documents are required, you’ll be notified via email. If there’s no response will NH make up to three phone call attempts before canceling the request.
Accurate contact information: NH will use the phone number you provide during registration, ensuring no mismatched numbers.
Consistent verification forms: All applicants, including third parties, will follow the same verification process.
Limited verification attempts: You can only pass verification once every seven days, preventing multiple registrations if initially verified. If verification fails, you can submit a new request.
New registration screen features:
The first screen now includes additional bullet points for the new process.
The “About You” page has two new fields:
A “practice verification document” is required for all registrations.
Successful identity verification requires matching data on file and correct answers to a three-question quiz.
We’re excited about these improvements and are here to support you through the registration process. Register today and experience the enhanced NaviNet registration!
Great news about verifying coverage on NaviNet!
As we shared on Happening Now last month, we have an exciting update regarding the verification of coverage for our members. With our recent enhancements, you can now accurately verify coverage using just the member’s name and date of birth. This means you no longer need the prefix and Card ID number to confirm active membership with our Blue Cross and Blue Shield of Nebraska (BCBSNE) members.
We appreciate your attention to detail in ensuring our members receive the best service possible. Thank you for your continued dedication and support.
Authorization submission issues for OOS providers via Availity
Earlier this month, we informed you about this issue on Happening Now. As a reminder, we kindly request that you share this information with your respective teams as needed.
Issue:
The problem occurs when out of state (OOS) providers submit authorizations through Availity to their local payer.
The system fails to recognize the prefix, redirecting them to the Florida Blue landing page.
However, when they initiate the authorization process from the landing page, the system attempts to perform an eligibility check (which should be disabled) and requests a Provider Assigned Payer ID (PAPI), which OOS providers do not possess.
This results in the process failing.
Cause:
This issue is a result of UI changes implemented in Availity last year.
We are actively collaborating with Availity to resolve this problem in production.
A definitive date for a full fix is still being discussed and determined.
Next Steps:
We are working closely with Availity to resolve this issue as soon as possible.
In the meantime, OOS providers experiencing this issue should call the phone number on the back of the member's ID card to submit their authorization requests.
In order to obtain proper reimbursement for Medicare Advantage (MA) claims, please follow Original Medicare billing and coding guidelines. This information can be found by going to CMS.gov and searching for the appropriate topic.
Reminder: MA auto approval for Skilled Nursing Facility admissions
Effective Jan. 1, 2025, BCBSNE began the new process to automatically approve the first seven days in a Skilled Nursing Facility for all MA PAR providers.
Notification of Admission is required within 72 hours of admission.
Notification of Admission:
This can be provided via NaviNet by submitting an authorization and allowing access to the authorization if a continued stay review is needed.
If continued stay review is needed, you can access the authorization to conduct your review via NaviNet, but only if the initial review was submitted via NaviNet.
Alternative notification methods:
Fax to the UM fax line: 1-866-422-5120
Call the UM phone line: 1-877-399-1671
Concurrent authorization review:
Required to certify additional days
Ensures timely issuance of Notice of Medicare Non-Coverage to the facility and the member
If faxing the medical records, please fax the documents by noon the day they are due to maintain timeliness of the review
BCBSNE is committed to the health and well-being of our members and communities we serve.
TriWest is currently experiencing system issues, which may affect the availability of information for providers. This includes technical issues with the referral/authorization tool.
Providers should use the following TriWest resources:
Adding Individual Providers to the TRICARE Roster: Submit through the BCBSNE credentialing process on the credentialing page above
Adding New group Individual Providers to the TRICARE Roster: Submit through the BCBSNE credentialing process on the credentialing page above
Adding Existing group Individual Providers to the TRICARE Roster: Submit changes through CAQH Provider Data Portal to have the provider’s information updated
Credentialing Variances for TRICARE Network in Nebraska:
Licensure Disciplinary Actions: Providers with actions on their state licenses cannot be offered participation in the TRICARE network
Board Certification: PAs, CRNAs, and CNMs must be board certified to be offered participation in the TRICARE network
Provisional providers-excluded from TRICARE network.
Accreditation Requirements:
Birthing Centers: Must be accredited by TJC, AAAJHC, CABC, or AABC and licensed according to state and local laws
Substance Use Disorder Rehab: Must be accredited by TJC, CARF, or COA
Intensive Outpatient Programs (IOP): Must be accredited by TJC, CARF, or COA
Psychiatric Residential Treatment Facilities: Must be accredited by TJC, CARF, or COA
Residential Treatment Centers (RTC): Must be accredited by TJC, CARF, or COA
Note: These requirements differ from our regular requirements, as we only verify accreditation but do not require it.
Change to audiology testing
Effective Feb. 1, 2025, dispensing fees are no longer included as part of the hearing aid purchase. If billed separately, these fees will not be denied as a provider contractual write-off. This change was communicated on Jan. 21, 2025, via our Happening Now update.
Exciting news for our provider community: CPAP authorizations!
As we shared in January on Happening Now, we are thrilled to announce a major win for our provider community! Effective Jan. 10, 2025, BCBSNE no longer requires preauthorization for the following codes related to continuous positive airway pressure (CPAP) devices:
E0601
E0561
E0562
This change means more streamlined processes and less administrative burden for you, allowing you to focus more on patient care.
But that's not all! BCBSNE has also decided to reprocess claims received for dates of service beginning Jan. 10, 2025. Any claims previously denied will be automatically reprocessed, so there's no need for you to submit a reconsideration request. This is our way of showing our commitment to making your experience as smooth and hassle-free as possible.
Thank you for your continued partnership and dedication to providing excellent care. We are excited about this change and believe it will make a significant positive impact on your practice.
Medicare billing for MFTs and MHCs effective Jan. 1, 2024
As we shared on Happening Now earlier this month, effective Jan. 1, 2024, Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs) can independently bill Medicare for services related to the diagnosis and treatment of mental illnesses. Medicare Part B will reimburse MFTs and MHCs at 75% of the rate paid to clinical psychologists under the Medicare Physician Fee Schedule.
Important Information for Providers:
Medicare opt-out status: If you have opted out of Medicare, please be aware that BCBSNE requires an affidavit from Medicare confirming your opt-out status with each claim submission. Without this affidavit, your claims will be denied for Medicare Explanation of Benefits (EOB).
Opt-in opportunity: We encourage MIDA providers to consider opting in to Medicare, as you now have the ability to do so. This change allows you to expand your services to Medicare beneficiaries and streamline your billing process
Please ensure that you are familiar with these updates and take the necessary steps to comply with the new requirements.
If the information on an already processed claim is incorrect or charges need to be added or voided, please submit a corrected claim electronically.
Steps to submit a corrected claim electronically:
Enter claim frequency type code: Place a value of 7 (replacement of prior claim) or 8 (void/cancel of prior claim) in Loop 2300 Segment CLM-Claim Information Field 05-3-Claim Frequency Type Code in the 837 file.
Provide original claim number: Enter the original claim number assigned by BCBSNE in Loop 2300 Segment REF*F8 - Payer Claim Control Number Field 02-Reference Identification.
Corresponding elements on CMS claim form: These two element/segment values on the electronic claim form correspond to Box 22 on an 837P or Boxes 4 and 64 for an 837I (Claim Frequency Type Code and Claim Original Reference Number/Document Control Number) on the CMS claim form.
Type of bill (TOB) 7: Indicates you are replacing a previously submitted claim. Do not change or remove data that needs to process again – submit the complete claim with the changes made.
Voiding and resubmitting claims
Voiding incorrect claims: Claims submitted and processed under an incorrect patient and/or member identification (ID) number will need to be voided before a new claim is submitted. Resubmit the claim as it was originally submitted, but with a claim frequency code 8 to void the inaccurate claim record.
Submitting a new claim: Submit a new claim with correct patient and/or ID information using claim frequency code 1. Claims with frequency code 1 do not need a claim number submitted in the original reference number field.
Submitting corrected claims with attachments
If you are not able to file your corrected claim 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 Request form.
NaviNet is available to dentists to check claim status, eligibility and benefits and fee schedules. The online portal is offered at no cost to our providers. It’s easy to use and gives you a dashboard to access helpful information for your BCBSNE patients. If you have not tried NaviNet, we encourage you to do so.
ID cards and schedules of benefits (SOB) for BCBSNE members are also available in NaviNet. To view BCBSNE member ID cards and SOB summaries, choose the Eligibility and Benefits workflow and then enter the information for the member you wish to search. Note: The BCBSNE member ID does not need to be included to search.
Do you have a new team member who would like to be added to our email list?
They can sign up for Provider updates online in the same location as our Provider Updates newsletter on the Alerts and Updates page.
You are receiving this because you are identified as a provider for Blue Cross and Blue Shield of Nebraska.
NaviNet® is a healthcare provider portal providing services for Blue Cross and Blue Shield of Nebraska, an independent licensee of the Blue Cross Blue Shield Association. Availity is a healthcare information technology platform providing services for Blue Cross and Blue Shield of Nebraska, an independent licensee of the Blue Cross Blue Shield Association.
