Blue Cross and Blue Shield of Nebraska (BCBSNE) will be closed on Monday, Dec. 25 and Monday, 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.
Top three claim return reasons
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.
Appointment availability surveys starting January 2024
To comply with regulatory requirements, BCBSNE has established appointment availability standards to ensure timely access to care for all members. In-network providers agree to maintain appointment availability standards. Starting mid-January 2024, your office may be contacted via a phone survey to assess compliance.
Some of the survey questions will ask how soon a current patient can be seen for routine/non-urgent care.
Provider Type
Standard for Routine/Non-Urgent Care
Primary Care Provider
Within 15 business days of patient request
Specialty Care Providers
Within 30 business days of patient request
Behavioral Health Providers
Within 10 business days of patient request
The survey also asks about how soon a current patient can be seen for urgent care and emergent care.
Some calls will occur after hours to assess your practice’s after-hours coverage. All provider types must maintain standards for urgent care, emergent care and after-hours access. Please ensure your office complies with at least one of the following acceptable actions:
Standards
Acceptable Actions
Urgent Care
Appointment can be scheduled within 24 hours from patient request
Available for patient to walk in and receive care
Triage is available with a nurse or other provider
Patient is instructed to go to the urgent care, nearest ER or call 911
Emergent Care
Available for immediate face-to-face medical attention
Available for patient to walk in and receive care
Triage is available with a nurse or other provider
Patient is instructed to go to the nearest ER or call 911
After-hours
Live party is available after-hours
Recorded message includes instructions on how to reach a live party
Recorded message provides emergency instructions to go to the nearest ER or call 911
Please make sure the individual(s) responsible for patient scheduling are familiar with the appointment availability standards at NebraskaBlue.com/Credentialing. Providers who do not meet the standards may be required to complete a corrective action plan.
University of Nebraska joining Blue Cross and Blue Shield of Nebraska (BCBSNE) in 2024
Approximately 33,000 University of Nebraska employees and their dependents will have BCBSNE health insurance coverage starting on Jan. 1, 2024.
BCBSNE’s University of Nebraska members will be part of the University NE System Network. Their prefix is UNE.
University of Nebraska members will have a three-tier network for their medical plan. University NE System Network providers are Tier 1. Members will pay less out of pocket when using the University of NE System Network providers. NEtwork BLUE providers are Tier 2, and Tier 3 is for all other providers.
Their member ID cards will have “University of Nebraska System” displayed in the upper right corner. Please see the sample ID cards below:
Medical and dental:
Medical only:
Dental only:
Reconsideration vs Timely Filing
Please be sure you are using the reconsideration form for coordination of benefits (COB), workers’ compensation and subrogation adjustments instead of a timely filing override request.
If you are notified by another carrier that a member’s Blue Cross and Blue Shield (BCBS) insurance is primary, you should submit a reconsideration form with the primary recoupment or denial. Do not send a timely filing override request.
Beginning Jan. 1, 2024, we will no longer return the incorrectly filed requests. You will be responsible for correctly submitting the COB, workers’ compensation and subrogation adjustments.
Provider Directory: Make Sure Your Information is Correct
All providers, including dentists, can review directory information in NaviNet. Directory information is located under Practice Documents in NaviNet. Please take a few minutes to review your online directory information to help ensure BCBSNE members can locate your most current information.
Streamlining the Process for Provider Directory Updates
Effective Jan. 16, 2024, BCBSNE will begin using the (Council for Affordable Healthcare) CAQH directory solution, called DirectAssure.
DirectAssure works with the CAQH Provider Data Portal, formerly known as CAQH ProView. Today, 85% of in-network providers use CAQH to submit their information and share it with multiple health plans.
BCBSNE will automatically receive updates you submit in CAQH for the following items:
Name (first, middle, last)
Suffix
Office telephone number and extension
Fax number
Primary email address
Location additions and terminations
Gender
Date of birth
Languages spoken
Accepting new patients
NPI
Provider type
Primary practice indicator
By submitting the update in CAQH, you do not need to complete and send the BCBSNE Provider Add/Extend/Transfer, Change of Address, or NPI form—saving you time and effort. Demographic changes will be updated in the provider directory within 48 hours from submission.
BCBSNE will receive notification of taxonomy updates. If you are a credentialed provider, any newly added locations will inherit your established taxonomies. Please allow up to 30 days for taxonomy, NPI and provider type changes. New taxonomies will be prioritized if recredentialing is needed.
Effective March 1, 2024, BCBSNE will no longer make updates from the previously mentioned forms. Changes must be submitted and attested-to in CAQH. Using this process ensures the directory reflects the most current information for our members and improves claim processing accuracy. Attesting to your information in CAQH also replaces the requirement to review your provider directory information every 90 days in NaviNet.
Please note there are no changes to the processes below. The appropriate instructions and forms can be found in NaviNet.
Adding or updating EFT information
Adding or updating ERA information
Terminating all locations
Adding Provisional Providers
Updating information for facilities/institutions
If you do not have a CAQH profile, please create one as soon as possible. For more information on creating a profile and using the CAQH Provider Data Portal please visit Proview.caqh.org.
Delegations/PHOs handling their own credentialing should continue to follow their current processes, including sending a full roster file every 90-days. If providers covered under a delegation agreement have a CAQH profile and are attesting to their data for their location handled by the Delegation, BCBSNE will automatically receive and make updates for the 13 items listed above.
Do you have a new team member who would like to be added to our email list?
They can sign up to receive an email when a new edition of Provider Update and Provider Bulletin have been added to our Alerts and Updates page.
