BCBSNE Medicare Advantage Provider Learn a Latte in-person events
Join the Blue Cross and Blue Shield of Nebraska (BCBSNE) team to learn more about our Medicare Advantage (MA) product coming in house for 2025. The event will delve into all things MA. We will also be exploring the improvements to the provider experience regarding utilization management, preauthorization, online resources and customer experience.
The same information will be presented at each session. A virtual session may be held at a later date to be determined. If a session has low participation, we will reach out to you via email to advise that the date will be consolidated with another session.
The event will be in the Aksarben Conference room on the first floor of the Blue Cross Centre at 1919 Aksarben Drive, Omaha, NE 68180. Greeters will be outside the door of the conference room to check you into the event.
Coffee, tea and light snacks will be provided.
Please be sure that each person attending registers for the event with the links below to assure enough food and drinks are available.
To help providers submit accurate claims and take advantage of auto-adjudication, 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.
Modifier is missing, not legible or is invalid for procedure code.
Please be sure to add the appropriate modifiers as this additional information helps to make sure your claim gets paid correctly for the services rendered.
Modifiers indicate that a service or procedure performed has been altered by some specific circumstance, but not changed in its definition or code. They are used to add information or change the description of service to improve accuracy or specificity. Keep in mind that the use of modifiers should always follow the guidelines set by the American Medical Association (AMA) and other relevant coding authorities.
Revised Medical Policies, effective Sept. 1, 2024
V.58 Oncology: Algorithmic Testing
VIII.7 Adjustable Cranial Orthoses for Plagiocephaly and Craniosynostosis
III.239 Lower Esophageal Myotomy for Treatment of Achalasia
BCBSNE Provider Procedures Name Update
Our Policies & Procedures page has been renamed to BCBSNE Provider Procedures. The searchable format to access these procedures has not changed, but the name has been updated to be more inclusive of the information you are able to search for.
Claim reconsideration requests: please synchronize your supporting documentation before sending the request in NaviNet®
When uploading supporting documentation, click on the file in NaviNet® to open it. If you cannot open it the file is corrupt. BCBSNE is unable to process reconsideration requests when the supporting documentation PDF file comes to us corrupt.
To help prevent this in the future, when you upload supporting documentation to NaviNet, you should ensure your system has fully allowed the PDF to sync with your computer drive, otherwise the process is interrupted and when you go to upload, it's not an accessible file to the receiver (BCBSNE in this case).
For BCBSNE members, please fax a new recon for this claim, as this recon will still show Open in NaviNet until 45 days from when it was originally submitted.
For members with another Blue’s plan, you may submit a new reconsideration in NaviNet for this claim as NaviNet closes the previous submission right away.
Breast cancer awareness – early detection saves lives
Except for some forms of skin cancer, breast cancer is the second most common cancer among American women regardless of race or ethnicity. But breast cancer does not just happen in women. Anyone born with breast tissue can get breast cancer. The American Cancer Society says when breast cancer is detected early, and in the localized state, the five-year relative survival rate is 99%.
Advances in breast cancer screening allow health care professionals to diagnose breast cancer earlier. Finding the cancer earlier makes it much more likely that the cancer can be cured. Even when breast cancer cannot be cured, many treatments exist to extend life.
Please educate your patients to know the signs and symptoms and to make an appointment as soon as they notice any changes, such as:
A breast lump or thickened area of skin that feels different from the surrounding tissue.
A nipple that looks flattened or turns inward.
Changes in the color of the breast skin.
Change in the size, shape or appearance of a breast.
Changes to the skin over the breast, such as skin that looks dimpled or looks like an orange peel.
Peeling, scaling, crusting, or flaking of the skin on the breast.
Women who have dense breast tissue have a higher risk of breast cancer compared to women with less dense breast tissue and should have both a mammogram and breast ultrasound each year. Dense breast tissue is not abnormal or harmful. However, cancer can “hide” in dense tissue because they look the same on a mammogram image. On an ultrasound, diagnostic radiologists can see what they cannot see on the mammogram. Studies have shown that breast ultrasound and possibly magnetic resonance imaging (MRI) can also help find some breast cancers that can’t be seen on mammograms.
Medicare Preauthorization Update for Medical Specialty Drugs
BCBSNE is committed to providing our members with access to high-quality health care that is consistent with evidence-based, nationally recognized clinical criteria and guidelines. Therefore, we will be implementing a change in the way we manage certain specialty drugs that fall under the medical benefit for our Medicare members. This new program will be administered by the Medical Pharmacy Solutions team at Prime Therapeutics (Prime).
Beginning Jan. 1, 2025, providers should begin contacting Prime to obtain prior authorizations for the in-scope drugs for our Medicare members with dates of service on or after Jan. 1, 2025.
You will be able to complete the prior authorization process via NaviNet or phone. Prior authorization will be required for the medical specialty drugs when they are administered in the following settings:
Physician Office (POS 11)
Patient Homes (POS 12)
Outpatient Facilities (POS 19, 22)
The Medical Pharmacy Solutions team at Prime will be hosting web-based training sessions in November of 2024. Please watch your email and our Medicare Advantage Happening Now page for updates and additional information.
Medicare Advantage Happening Now Articles will be Moving
In the upcoming months we will be implementing changes to our Medicare Advantage page. The first of these exciting changes is the transition of our MA Happening Now articles. All Happening Now information specific to MA will now be located on the MA page.
Now you will be able to view all the articles regarding MA in one place. Be sure to keep an eye on the Medicare Advantage page for future updates, this will be your "one stop" page for MA as we move this business in house.
Medicare Advantage Provider Procedure Updates
Currently the MA Procedures are housed as PDF documents on our Medicare Advantage Policies page. As we begin moving our support of our MA program fully in house, we will also be updating how the MA Provider Procedures are delivered in 2025.
Effective Jan. 1, 2025, you will be able to use the BCBSNE Provider Procedures search tool to locate MA procedures. When searching for a MA procedure with a keyword in this tool, you can filter the policies by selecting the Medicare Advantage tag on the left-hand side of the search results.
For more information on the BCBNE Provider Procedures you can review the eLearning under the Provider Academy.
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 at 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. Prime Therapeutics LLC is an independent company providing pharmacy benefit management services for Blue Cross and Blue Shield of Nebraska, an independent licensee of the Blue Cross Blue Shield Association.
