Our dedicated provider portal, NaviNet®, is the preferred method for contacting Blue Cross and Blue Shield of Nebraska
Blue Cross and Blue Shield of Nebraska (BCBSNE) has made significant enhancements to the provider portal, NaviNet, as part of our Blue Goes Green initiative. This initiative aims to drive efficiency and effectiveness by reducing manual processes, minimizing paper use and improving online access.
To expedite your experience, it is essential to register for NaviNet, which is provided at no cost for our in-state providers and only requires a Federal Tax ID. If your office already uses NaviNet, your Security Officer can create an account for you. If not, you can begin the registration process at Register.NaviNet.net.
Enhanced self-service tools:
NaviNet offers a range of self-service tools, including:
Benefits and eligibility verification
Preauthorization and precertification requests
Claims status
Claim investigation
Appeal and Reconsideration
Timely Filing requests
Recent enhancements:
To streamline and simplify online communications, enhance security and eliminate previous frustrations the following recent enhancements have been made:
2024 Q4:
Introduction of a new claim appeal status
Improvements to the preauthorization/precertification process
2025 Q1:
Transition of timely filing requests to NaviNet
Retirement of the urgent radiology preauthorization request line
Updates to the NaviNet registration process
Improvements in coverage verification
For more detailed information, please refer to past issues of the Provider Bulletin. BCBSNE is committed to making your experience with NaviNet as efficient and user-friendly as possible.
Keep an eye on Happening Now and the Provider Bulletin for more exciting updates from the Blue Goes Green initiative in the future.
Nebraska's Compact Licenses: Enhancing provider mobility with BCBSNE
Initiated in 2017, Nebraska's Compact Licenses offer a streamlined process for providers to obtain licensure in multiple states. This initiative reduces the administrative burden for providers, allowing greater mobility and flexibility in their practice. Providers must meet strict requirements, including having no issues with their application or record and being board certified. By simplifying credentialing, providers can serve patients across state lines more effectively, improving access to care and overall provider satisfaction.
Starting April 1, 2025, psychologists are now eligible for Compact Licenses. This inclusion broadens the scope of the compact licensure initiative, offering more providers the opportunity to benefit from this efficient system.
Nebraska's Compact Licenses simplify credentialing for BCBSNE providers, making it easier for qualified professionals to practice across state lines. With the inclusion of MDs, DOs, MBBS holders, physical therapists and psychologists, the state continues to enhance the licensure process, ultimately improving access to care and provider satisfaction.
Action needed: Provider Executive inquires update
BCBSNE Provider Executives are available to support providers with the following:
Timely Filing Reviews submitted via NaviNet
Escalated Claims Inquiries
Provider Agreement Inquiries
Provider Data Changes
Effective May 1, 2025, you will be able to submit your inquiries to the Provider Executive team via the new Advanced Provider Inquiries form on NaviNet. This form will collect all the required information needed to address your questions, thereby streamlining the process and reducing the number of communications.
Please note: This new form does not replace the existing Claims Investigation process available on NaviNet. You will still need to submit a Claims Investigation request before contacting the Provider Executive team via the Advanced Provider Inquiries form.
As of May 1, 2025, the ProviderExecs@NebraskaBlue.com email account will be decommissioned, and you will no longer be able to send requests to this email address.
For additional updates, including an eLearning module, please refer to Happening Now as the effective date approaches.
Action needed: Input survey for BCBSNE Western Nebraska Provider Summit
We are pleased to announce that on Tuesday, July 15, we will be hosting a Western Nebraska Provider Summit in Kearney, Nebraska. This event is designed to provide valuable insights and updates on BCBSNE commercial and Medicare Advantage (MA) lines of business.
Our focus is on our provider partners west of Omaha, and we highly value your input to tailor the summit to meet your needs. Please take a moment to complete the survey below by Thursday, May 1 to let us know your preferences and any specific topics you would like to see covered.
Please note that this event will focus exclusively on medical topics. However, we are planning to host a behavioral health and dental forum in late 2025 or early 2026.
We look forward to your participation and to making this forum a valuable experience for all attendees. Please keep an eye on Happening Now in May for more information on the event and how to register.
Transition to electronic remittance advices and payments in 2025
BCBSNE continues to further our Blue Goes Green efforts with a shift toward electronic remittance advices and payments starting in 2025. Here are the key points:
No more paper remittance advices or checks: Providers will need to transition to electronic remittance advices (835s) and electronic payments.
Sign up with a clearinghouse: Providers can receive 835s by signing up with a clearinghouse or accessing them in NaviNet.
Electronic Funds Transfer (EFT): Providers currently receiving paper checks will need to fill out an EFT form to receive electronic payments.
Forms available on NaviNet: The necessary forms for signing up with a clearinghouse and enrolling in the electronic remittance advice service are available under the Administrative Updates/Secure Forms link on NaviNet.
Exception for dentists: Due to limited self-service options in NaviNet, dentists can continue receiving paper remittance advices if they cannot enroll with a clearinghouse.
This transition aims to streamline processes and reduce administrative burden as well as paper usage. Please complete these steps as soon as possible. A final date to complete this transition is coming soon. Watch Happening Now for the last day to receive paper remittance advices and checks.
How to submit a claim
The preferred way to submit claims is through the EDI. Claims can be submitted through your preferred clearinghouse as long as you are a BCBSNE-credentialed provider. If you do not already have a clearinghouse, BCBSNE offers free billing software and support to help you submit claims electronically. Learn more about the Electronic Data Interchange and PC-ACE Software.
If circumstances necessitate submitting claims on paper temporarily, please inform your Provider Executive. This notification will enable us to prepare for the receipt of paper claims and help mitigate any potential downstream delays.
Attention needed: Denied MA claims with frequency limits
BCBSNE recently identified an issue with the processing of certain MA claims that have frequency limits, such as mammograms. Here are the key points:
Issue identified: When both facility and professional claims were submitted for services with frequency limits, only one of the two claims was allowed. The claim processed last was denied with the message: "This procedure exceeds the maximum frequency allowed per Medicare Advantage guidelines."
Correction implemented: The issue has been identified and corrected. All claims processed after March 25, 2025, are now being handled correctly.
Reprocessing affected claims: BCBSNE is identifying and automatically reprocessing the affected claims that were processed incorrectly between Jan. 1, 2025 and March 24, 2025.
No action required: There is no need to resubmit these affected claims. Please allow 30-45 days for the reprocessing of these claims.
Coming Soon: New edits for Local and HOST MA claims
Billing MA claims accurately is crucial for providers to ensure timely reimbursement and compliance with regulations. Currently, we are seeing MA claims with a 114 TOB being billed where the member was admitted in 2024 but the statement dates on the 114 TOB claim are all in 2025.
To address this issue, BCBSNE will soon introduce new edits to reject specific TOB/REV Code combinations or TOB/Status Code combinations. Here’s a guide to help providers navigate these changes and maintain consistency in billing practices.
Understanding TOB codes
Type of Bill (TOB) codes are essential for indicating the nature of a claim. For Medicare billing, certain TOB codes are valid, while others are restricted. Here are the key points to remember:
TOB 112: This code is valid for Medicare billing. Hospitals should use TOB 112 for initial interim claims, indicating that a patient is expected to remain in the facility for an extended period.
TOB 117: After the initial interim claim has been submitted, TOB 117 should be used for continuing and final claims. This ensures that the billing reflects the ongoing care and eventual discharge of the patient.
Avoiding invalid TOB codes
Certain TOB codes are not valid for Medicare PPS claims. Providers should be aware of the following restrictions:
TOB codes 0XX3 and 0XX4: These codes are not valid on Medicare PPS claims. Providers must resubmit claims with the appropriate TOB 0XX7.
Interim continuing and final claims: Instead of using TOB 0113 or 0114, providers should submit claims using TOB 0117. This involves submitting an adjustment to cancel the original interim bill and rebilling the stay from the admission date through the discharge date.
Consistency in billing rules
By following the guidelines outlined above, providers can ensure their claims are processed correctly and avoid rejections due to invalid TOB codes.
Conclusion
Adhering to the proper billing practices for Medicare claims is essential for providers to maintain compliance and ensure accurate reimbursement. By understanding and applying the correct TOB codes, providers can navigate the edits and continue to deliver quality care without disruptions in billing.
For any further questions or clarifications, providers should reach out to their billing support team or consult the latest Medicare billing guidelines.
Reminder: Observation vs. inpatient admission prior authorizations
BCBSNE would like to remind providers of the following guidelines regarding MA prior authorizations (PA):
Observation level of care: No PA submission is required for Observation level of care.
Inpatient admissions: PA is required for inpatient admissions.
Upgrading from Observation to inpatient: If a patient is upgraded from Observation to an inpatient level of care, please submit a PA request via NaviNet. Ensure that the observation dates are included to bundle the observation days with the Diagnosis-Related Group (DRG) for claims and billing purposes.
BCBSNE transitions to new telehealth vendor for its employees - Telescope Health
Starting Tuesday, April 1, 2025, BCBSNE transitioned our employee health plan telehealth provider from Amwell to Telescope Health.
Our employees may continue to seek telehealth services through their current physician/provider, or they can receive services through Telescope Health for their telehealth needs.
At Telescope Health, they make patient care seamless through effortless collaboration. With patient consent, their Automatic Patient Record Sharing — powered by Athenahealth — securely connects providers across care locations. Integrated with CommonWell and Carequality health data exchanges, it reduces administrative work and streamlines care transitions.
As the primary care or specialty provider, you can receive access to your patient’s medical information if they complete a telehealth visit with Telescope Health and consent to sharing, ensuring continuity of care without extra steps.
We believe this change will improve telehealth services for our employees. If you have any questions, please contact us.
Thank you for your support and dedication to providing exceptional care.
Billing with telehealth: Approved taxonomy
It's crucial to include the correct telehealth-approved taxonomy code on your claim line items for successful processing. This ensures your claims are recognized as telehealth services and processed correctly.
Key Points:
Include the taxonomy code and necessary modifiers on the claim line: Add the telehealth taxonomy code directly on the claim line item and use modifiers like 95 (synchronous telemedicine) or GT (interactive audio and video) to specify telehealth services.
Match credentialed information: Ensure the taxonomy code matches the one credentialed and approved by BCBSNE to avoid claim denials. For a listing of provider types please reference our Provider Procedures GP-X-016
Submit corrected claims if needed: If a claim is denied, submit a corrected claim with the correct telehealth taxonomy code
Reminder: Updated TriWest information for BCBSNE providers
TriWest is experiencing an ongoing issue affecting remittances and is currently at the highest level of escalation.
There is no estimated time for resolution at this moment. Continue to check Happening Now for updates.
Important Updates:
April 1, 2025: The TRICARE West Region Referral Waiver has been extended through April 30, 2025.
April 1, 2025: Behavioral health counselor claims were denied due to a supervisory requirement error. TriWest has corrected this issue and is working to reprocess the claims.
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 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.
