To help providers submit accurate claims and take advantage of auto-adjudication, Blue Cross and Blue Shield of Nebraska (BCBSNE) continues to rank the top three reasons for claim returns:
The Federal Tax Identification number (TIN) and/or the NPI number for the Provider, Rendering or Referring, is not effective for the date of service.
Please ensure you are submitting TIN/NPI of providers who are credentialed with BCBSNE. Most importantly, do not submit claims for newly-credentialed providers until you have the acceptance letter with the provider’s effective date.
For credentialing guidance, please visit NebraskaBlue.com/Credentialing or the Administrative Updates/Secure Forms link on the BCBSNE NaviNet landing page.
The provider’s name and credentials, Federal Tax Identification number and/or NPI are missing.
The required BCBS subscriber identification number is missing or invalid.
Please verify this information an resubmit your claim with the complete identification number as it appears on the member’s BCBS identification card in the correct ID number field.
It is recommended that you photocopy the patient’s member ID card at every visit to ensure you have the most up-to-date coverage information.
The ProviderPortalAuthQuestions@NebraskaBlue.com email address is no longer available. Please see our eLearning video, NaviNet Preauthorization, for guidance in submitting and viewing preauthorization and precertification requests. For additional tips and resources, please see our Preauthorization page.
Effective Jan. 1, 2024, BCBSNE will not cover CPT 99459
CPT 99459 is direct practice expenses associated with performing a pelvic exam in the non-facility setting. Keep in mind that while you can bill this code, BCBSNE considers this service as inclusive; therefore, included in the allowance for the pelvic exam. It is not necessary to submit a reconsideration request as these denials will be upheld.
Reminder: Self-Serve with new claim denial information available in NaviNet®
As we announced on Dec. 29, 2023, new enhanced denial messages are now available in NaviNet®. This new information is intended to save your office time when checking claim status and avoid the need to contact Customer Service or send a note via claim investigations.
In NaviNet, after performing a Claim Status Search, specific denial messages will be shown for each denied claim line in Claim Status Details. Denial messages corresponding to the claim line number will be displayed directly above the Claim and Service Line Details.
Our top three denial reasons are inclusive, included and duplicate. A couple of things to note:
The enhanced messaging can be reviewed on all claims in NaviNet. (Pre/post implementation of the new messaging.)
Inclusive/Included Denials: Claims denied inclusive will reference the claim number and CPT code the claim line denied inclusive too. Keep in mind, not all inclusive or included denials deny inclusive to another claim or CPT code. An example is non-billable charges. In this scenario, a message will still be displayed advising the claim line denied inclusive, but it will not reference another claim or CPT code.
Duplicate Denials: NaviNet will advise what claim(s) the claim is denying as duplicate to. Keep in mind, if claim C denies duplicate to claim B, and claim B denies duplicate to claim A, claim C is going to show the claim # for claim B - not for the original claim A.
Exception: Non-Nebraska duplicate denials, as those are determined by the member’s plan.
Reduction in payment denial: NaviNet will show when a payment reduction has been made and the claim number/CPT code to reference when a payment reduction has been made. BCBSNE expects providers to self-service when questioning why the full allowed amount was not used during the claim’s processing rather than opening a claims investigation.
Reminder: Claim Return letters are going paperless on April 1, 2024
On Jan. 30, 2024, we posted in Happening Now that, beginning April 1, 2024, BCBSNE will no longer mail claim return letters to our participating network health care professionals and facilities for BCBSNE plans. BCBSNE will instead post them on NaviNet under Patient Documents.
Effective May 15, 2024, we will be adding Reconsideration and Appeal letters to this paperless process.
View the eLearning video for your reference in the Provider Academy.
If you cannot locate the letter(s), please reach out using the Claims Investigation tool explaining the steps you took in attempting to locate the letter(s) and the issue you encountered.
Reminder: Multiple Procedure Payment Reduction (MPPR) for Diagnostic Imaging Services
Effective April 1, 2024, BCBSNE will apply a payment reduction when multiple eligible diagnostic imaging services are provided to the same patient on the same day by the same provider or different providers within the same group practice.
Aligning with the Centers for Medicare & Medicaid Services, MPPR on certain diagnostic imaging services applies to the professional component and technical component services. It applies to both professional component-only services, technical component-only services, professional component and technical component of global services and to multiple units of the same technical component and professional component services.
Full payment is made for each professional component and technical component service with the highest payment under the Medicare Physician Fee Schedule for the procedures with a multiple surgery value of ‘4’ in the Medicare Fee Schedule database. Payment is made at 95 percent for subsequent professional component services. Payment is made at 50 percent for subsequent technical component services.
Professional claims with diagnostic imaging services should be submitted with a single date of service on each line.
Dental: Orthodontic claims for University of Nebraska members
On Jan. 1, 2024, University of Nebraska employees and their dependents joined BCBSNE for their medical and/or dental coverage. These members have the prefix UNE, or, if their only coverage is dental, YZL. To ensure timely processing of your claims, please confirm the date of service is on or after Jan. 1, 2024.
Please see policy number DP-X-004 if you need guidance in submitting orthodontic claims.
Medicare Advantage: BCBSNE is offering in-home health evaluations at no extra cost for our Medicare Advantage members.
BCBSNE has teamed up with Signify Health to provide our Medicare Advantage members with an in-home health evaluation. This is provided at no cost to the member and does not count against any benefits, so the member’s own PCP (Primary Care Physicians) could still complete an Annual Wellness Exam.
During this in-home health evaluation, the member meets with a licensed clinician who will review their medications and medical history. They will also check vital signs, look for safety risks, and answer any health questions the member might have.
BCBSNE provides our members with this no-cost service by Signify Health because it is:
Helpful — Get current information about their health to help them and you make informed decisions.
Convenient — We come to the member. There is no travel time or crowded waiting rooms.
Professional — Visit at home with a licensed medical doctor, physician assistant or nurse practitioner.
Personal — Enjoy up to an hour of one-on-one time to ask all their health questions in the comfort of their home.
Members can call 402-200-5548 (TTY: 711) to request an appointment.
A Signify Health coordinator will contact our members to invite them to have a Nurse Practitioner or Physician's Assistant come to their home. Virtual visits using a computer, tablet or smartphone are available upon request.
In-home health evaluations are administered by Signify Health, an independent company, on behalf of BCBSNE. For more information, visit hellosignify.com.
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