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, NH will 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!
Protecting patient information: The importance of photo ID verification
Identity theft is a growing concern in health care, where sensitive personal and medical information is handled daily. Implementing robust identity theft precautions is crucial to safeguard patient information and maintain trust. One effective practice is verifying photo IDs, which plays a significant role in preventing identity theft and ensuring accurate patient identification.
Benefits of photo ID verification
Accurate patient identification: Ensures the person receiving care is the patient on record, reducing medical errors.
Enhanced security: Adds an extra layer of security, making it harder for individuals to use stolen identities.
Improved trust and confidence: Patients feel more secure knowing their information is protected, building trust in the provider-patient relationship.
By incorporating these measures into your daily operations, you can significantly reduce the risk of identity theft and enhance the overall patient experience.
Medicare Advantage value-based incentive program presentation
Blue Cross and Blue Shield of Nebraska (BCBSNE) is offering two exciting incentive opportunities to our participating Medicare Advantage (MA) providers for the role they play in caring for our MA members.
BCBSNE hosted a virtual town hall on Jan. 31, 2025, outlining the two program offerings below for clinics with MA member attribution of 20 or more:
Provider Excellence Program (PEP)
Incentives for performance in MA quality measures
Additional inventive for high performing entities achieving a high performance for certain quality measures
Upside only agreement
Chronic Condition Revalidation Incentive (CCRI)
Incentive for managing members with specified chronic conditions
Upside only agreement
The PDF of the Value-Based Incentive Program presentation is available on our Provider Academy.
BCBSNE conducts settlements on hospital claims for BCBSNE MA members. This applies to in network Critical Access Hospitals and Rural Health Clinic providers. Below are a few FAQ reminders on the MA interim reimbursement letters.
How do I submit my MA rate letter provided by CMS?
When submitting claims for services rendered in 2025, please use the updated MA ID numbers with the following prefixes:
YMA4 will replace YMAN as the prefix for the HMO product.
Y2M4 will replace Y2MN as the prefix for the PPO product.
This change will help reduce the likelihood of returned or denied claims.
Reminder: MA Ambulatory Surgical Center billing taxonomy
Ambulatory Surgical Centers (ASCs) must utilize the appropriate ASC billing taxonomy for MA claims to ensure accurate claim adjudication. This practice aids in accurately identifying the facility type and ensures that MA claims are processed correctly.
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
Adding New group Individual Providers to the TRICARE Roster: Submit through the BCBSNE credentialing process on the credentialing page
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.
BCBSNE pilots new well-being program with employees
BCBSNE has launched Amplify Health, a new pilot well-being program for its employees. The goal of Amplify Health is to improve health outcomes and lower costs for BCBSNE employees and their families.
The program is designed to equip employees with actionable data about their health, including their current and future health risk, diagnosed chronic conditions, reminders about preventive screenings and more. BCBSNE employees who elect our medical insurance coverage will receive a customized health profile based on their claims history. In 2025, employees are incentivized to complete an annual preventive exam and biometric screening.
As a provider partner, we wanted to make you aware of this new program. Pilot participants may bring a copy of their health profile to their appointments to discuss with their health care providers. In the future, BCBSNE will explore expanding this program to additional members.
Together, we can make a difference in the health and well-being of our members, your patients.
Streamline your appeals process with NaviNet
When submitting an appeal, it is crucial to select the correct Appeals Request Form instead of the Reconsideration Request Form. Using the incorrect form can lead to delays and prevent your request from being processed by the appropriate team.
By utilizing NaviNet, you can easily choose the correct form, ensuring a smoother and more efficient appeals process.
Reminder: Exciting updates for our provider community - preauthorization changes
As previously announced in Happening Now and our Provider Update Newsletter, we are implementing several significant changes to benefit our provider community and enhance patient care. Please note, these changes do not apply to our Medicare Advantage plans.
CPAP Authorization changes
As announced in January and in our February Provider Bulletin, effective Jan. 10, 2025, BCBSNE no longer requires preauthorization for the following CPAP device codes:
E0601
E0561
E0562
This change streamlines processes and reduces administrative burdens, allowing you to focus more on patient care. Additionally, BCBSNE will reprocess claims received for dates of service beginning Jan. 10, 2025. Any previously denied claims will be automatically reprocessed, eliminating the need for reconsideration requests.
Radiology/Imaging Policy updates
Lung cancer screening
On Feb. 18, 2025, we announced on Happening Now that, effective Feb. 15, 2025, policy IV.81 was revised to improve access to essential health services. Procedure Code 71271 no longer requires preauthorization or medical review. This update simplifies the process, reduces administrative tasks and supports early detection and better health outcomes for your patients. The InterQual criteria for commercial plans have been updated to reflect this change.
Myocardial perfusion imaging
On Feb. 28, 2025, we announced on Happening Now that, starting March 15, 2025, policy IV.81 has been further revised. The following CPT codes for myocardial perfusion imaging no longer require preauthorization or medical review for our commercial plans:
78451
78452
78453
These updates aim to streamline access to essential health services, reduce administrative burdens and enhance patient care.
We are committed to continuously improving our services and policies to better support your practice. If you have any questions or need further assistance, please contact our provider support team. Thank you for your continued partnership and dedication to providing excellent care.
BCBSNE introduces enhanced E-Consultation Policy effective May 1, 2025
Starting May 1, 2025, BCBSNE will implement a new and improved policy for e-consultation services, aimed at streamlining processes and enhancing provider efficiency. This policy update reflects BCBSNE’s commitment to supporting health care providers with clear and effective guidelines.
Guidelines for consulting providers:
Utilize procedure codes 99446-99449, 99451 or G0546-G0550 when billing for medical consultations.
Avoid billing for e-consultation services if a face-to-face encounter with the patient has occurred within the last 14 days.
Guidelines for requesting treating providers:
Use procedure codes 99452 or G0551.
These services can only be reported once every 14 days.
Submission guidelines:
Apply the Place of Service code that indicates your location when providing the service.
Note that e-consultation services with Place of Service codes 02 or 10 will be denied.
This policy update is designed to ensure clarity and consistency in billing practices, ultimately benefiting both providers and patients. BCBSNE is dedicated to facilitating seamless and efficient health care delivery through these enhanced guidelines. Providers are encouraged to familiarize themselves with these changes to ensure compliance and optimize their e-consultation services.
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.
