On Thursday, Nov. 28 and Friday, Nov. 29, Blue Cross and Blue Shield of Nebraska (BCBSNE) will be closed in observance of the Thanksgiving holiday. BCBSNE will also be closed on Wednesday, Dec. 25 and Wednesday, Jan. 1, in observance of Christmas and New Year’s Day. Please use NaviNet® for your eligibility, benefits and claim status needs during this time.
Preauthorization/Precertification process improvements on NaviNet
Effective Oct. 28, the following changes were implemented:
Only the numeric portion of the ID number needs to be entered for preauthorization requests. The alpha prefix is no longer required. However, claims must still be submitted using the full alpha-numeric ID number.
Notes or an attachment of medical records must be added before launching InterQual®. You will not be required to submit both.
For commercial business, when selecting criteria guidelines in InterQual please confirm you are not selecting the Medicare Advantage (MA) criteria.
Important: All BCBSNE MA members will receive new ID numbers starting Jan. 1, 2025. Please ensure you are using their new ID number for services to be received on or after Jan. 1, 2025.
Guidelines to prevent delays in preauthorization requests
To avoid delays in preauthorizations, please ensure you click the Policy Code Link when submitting an outpatient authorization after inputting the CPT/HCPC code. This step is necessary to successfully access the review criteria. In instances where the entered code does not retrieve the anticipated policy, please select “No Policy Applies.” Failure to select the policy code will result in delays in the review and decision of the preauthorization request.
Notice regarding preauthorization request withdraws in NaviNet
Effective Nov. 1, 2024, providers will need to contact us directly to withdraw a preauthorization request. If you need to withdraw a request, please call Customer Service. We’re here to assist you.
Handling duplicate line items with MUE limits
As we posted to Happening Now on Oct. 15, 2024, when duplicate line items are submitted for a service/item with a Medically Unlikely Edit (MUE) limit, the line-item denial reasons will be provided for both the duplicate claim/service and for exceeding the MUE limit.
MA split-year claim submission
Non-Nebraska Outpatient, Professional Claims and CAH Swing Bed
For outpatient, professional and CAH swing bed claims with charges incurred during different years, the charges must be submitted on separate claims. This requirement will be the same each year end for split-year claims.
Claims for non-Nebraska members that are not split will reject back to the provider upon submission.
For example:
If dates of service are from Dec. 15, 2024, to Jan. 15, 2025:
Submit charges incurred from Dec. 15, 2024, to Dec. 31, 2024, on one claim
Submit charges incurred from Jan. 1, 2025, to Jan. 15, 2025, on a separate claim
Claims submitted with charges incurred during both years on the same claim will be rejected back to the provider to split the claim.
Institutional Inpatient Claims
For inpatient* institutional claims, it is no longer required to split the entire claim for non-Nebraska members.
*Inpatient includes acute care hospital, psychiatric hospital, rehabilitation hospital, skilled nursing and swing-bed (excluding CAH swing bed).
Reminder: Emailing Provider Executives
Emails are handled in the order received; however, emails are not worked unless the below information is included.
Provider name, NPI and TIN
Claim numbers (if applicable)
Member name and ID
DOS
Expected outcome or reimbursement
Additionally, the appropriate steps MUST be followed BEFORE submitting an escalation request to this email box:
Step One: NaviNet
Please access NaviNet for all member, claim, authorization and appeal needs. If you do not have access to NaviNet please register by following the steps at Provider Academy.
Step Two: Contact
If NaviNet is unsuccessful, please use the claims investigation tool located in NaviNet.
Step Three: Escalating
For claim escalation needs that you are unable to resolve through NaviNet or Customer Service Claims (CSC) Investigation, you can email this email box and include why NaviNet or Claims Investigation was not successful. You should also include the inquiry number from Customer Service.
For fee schedules:
All fee schedules are available in NaviNet and will no longer be available via CSC, email or inquiry.
If you are affiliated with a PHO, you must obtain the fee schedule from the PHO.
For timely filing:
Please submit your request via NaviNet using the Timely Filing form.
Please remember: Coordination of Benefits (COB) is not a member ID exception. Please complete the reconsideration form on NaviNet if another insurance was billed, recouped or denied the claim and you then submitted to BCBSNE.
Provider Executives no longer address COBs submitted incorrectly on a timely filing form.
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.
