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Providers

Eligibility and Claims

Instantly check claims status and see member benefits and eligibility through our self-service tools. We use Electronic Data Exchange (EDI) and NaviNet to streamline and expedite the claim submission process.

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The best way to check member eligibility and review benefits is through NaviNet. You can also submit an inquiry through NaviNet to be reviewed by an expert representative. Please allow 3 business days for response.
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The preferred way to submit claims is through the Electronic Data Interchange (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 »

Quickly check the status of a claim through NaviNet. In response to your feedback, we are happy to provide enhancements to improve your service experience as well as provide efficient resolution of claim questions and inquiries. The below links will guide you in discovering the additional information we have made available on our Provider Caller Guide and are a great first step in claim resolution.

Service Enhancement Information       Provider Caller Guide

If you have already tried NaviNet, you can also inquire about a claim. Please allow 3 days for response.
Inquire About a Claim Online »

After you have attempted to resolve your question or issues twice using the online claim form, you may escalate to CSCClaims@NebraskaBlue.com. Please include your email inquiry numbers and a summary of your concern.

Log into NaviNet »

Please complete and return the EFT Enrollment Form. EFT-related requests are processed through our Health Network Administration Department.

While processing the EFT form usually takes no more than 24-48 hours during business days, the EFT payment start dates are not effective immediately.  EFT payment setups first have to go through bank verification timelines which will push the EFT start date until the 1st of the following month.  However if it is far enough into a month, it may be pushed out to the 1st of the month following that (for example if form is received and setup on 2/28, the EFT effective date will not be until 4/1 to allow for bank verification times).

After the EFT form has been received and processed, the provider should receive an email confirmation that will state what the effective date is for the EFT payments to start.

Register for Electronic Remittance Advice (ERA), (835)
To register for electronic remittance advice (ERA), complete the  Electronic Remittance Advice Enrollment Form. ERAs are routed by Tax ID and can't be split among different clearinghouses. Once registered, you ERA is available in NaviNet.

To adjust or replace a claim, please review the Replacement Claims in Section 8 of the General Policies and Procedures Manual.
View General Policies and Procedures Manual »


To adjust or replace a claim, please review the Claims Adjustment Reason Codes and Remittance Advice Remark Codes.

Claims Adjustment Reason Codes (x12.org)
Remittance Advice Remark Codes (wpc-edi.com)

Remittance Advice Format and Field Tips

You can also use PC-ACE, a free electronic claims processing software. The claims review software uses nationally accepted and sourced guidelines, including Current Procedural Terminology (CPT) regulations as documented by the American Medical Association (AMA), Correct Coding Initiatives (CCI) and Post-Operative Period Guidelines as outlined by the Centers for Medicare and Medicaid Services (CMS). 
More about PC-ACE and Remittance »

Note: Corrected or replacement claims must be filed electronically. Corrected claims submitted on paper by a provider with electronic claim filing capabilities will be returned with instructions to submit the corrected claim electronically. If your corrected claim includes attachments, your corrected paper claim must be filed to Blue Cross and Blue Shield of Nebraska, attached to a Reconsideration Request Form, as you have done in the past. If you have any questions regarding how to submit a replacement claim electronically, please refer to the HIPAA ANSI X12N 837P or HIPAA ANSI X12N837I implementation guide for detailed instructions.

Additional resources:

  • Medically Unlikely Edits (MUE) – Includes frequently asked questions on MUEs, along with updated MUE information.
    CMS.gov
  • National Correct Coding Initiative (NCCI) Edits – Provides guidance on the NCCI policy manual for Medicare Services as well as FAQs for NCCI edits for Iowa, Kansas, Missouri and Nebraska providers.
    wpsgha.com
Tips for Using NaviNet

NaviNet simplifies processes for the provider community. Learn how to find what you need by accessing the resources below.