Provider FAQs
Welcome to Our FAQ Section. On this page, you can easily navigate through various categories of frequently asked questions. Simply select a category to view the list of questions. Each question is displayed in an accordion format, allowing you to expand and view the answer with a single click.
NaviNet® FAQs
When looking at the claim in NaviNet, the detail is provided just above the claim-level information. It could be for another claim or another procedural code.
Non-Nebraska members claim denials are determined by the member’s plan and will not display in NaviNet.
The enhanced denial messages are exclusively available in NaviNet.
This will apply to claim denials for claim types: Professional, Institutional and Dental.
Enhanced messaging on claim denial reasons was added Dec. 29, 2023.
Please refer to your coder/biller for additional review prior to sending a claim investigation.
Each office must have a minimum of one Security Officer who is responsible for registering with NaviNet, adding users to the account, and granting user access. Your designated security officer should go to https://register.navinet.net to begin the registration process.
- Registration takes between five to seven business days.
- Registration requires a Tax ID and email address.
- Each user will have their own username and password. No sharing is allowed.
- Users have 60 days to log in for the first time before they will become disabled.
- Users should see their Security Officer to have their password reset if they become disabled.
- See the Provider Registration Flyer for more information.
You may check the status of your NaviNet registration at any time from the Registration Page or Help Center.
If you are an existing NaviNet user, and are either a participating BCBSNE network provider, or are a healthcare provider within the state of Nebraska, you should see Blue Cross and Blue Shield of Nebraska as an option in your Health Plans List.
Please verify that the phone number and address you entered when registering for NaviNet matches the phone number and address you have on file with BCBSNE.
If this information is valid and you are still unable to register, please email ProviderExecs@NebraskaBlue.com.
If you are not registered for NaviNet please see our Provider Academy page.
For providers who do not belong to a PHO and are not a newly credentialed provider, please follow the steps below. Please note: The Provider Executive Team does not send fee schedules. To access fee schedules, please log in to NaviNet®.
Your system administrator will need to give you access to Practice Documents. If they have any questions on how to do this, they will need to call NaviNet directly at 1-888-482-8057. If they already have, when you log in, under workflow you will need to click Practice Documents.
Your next steps will be to attest.
Once you attest you should be able to bring up the fee schedule. If you still cannot view your fee schedule, your system admin/security officer will need to change/update the user permission. It will state Security Office-User Permission and edit access and enable practice documents. If your system admin (or if you are the system admin) need assistance on this, please contact NaviNet directly at 1-888-482-8057.
NaviNet on new Windows 10 for Internet Explorer (or they can skip these steps and use Google Chrome):
- Go to the NaviNet login page.
- Prior to logging in, click the blue stop indicator in the URL line, between the lock and refresh.
- You’ll get a pop up, click “Turn off ActiveX Filtering”.
- This turns off the ActiveX Filtering for all downstream sites connected to the NaviNet login page. You’re all set!
Yes, all in-network providers, as well as the vendors supporting them, are required to use NaviNet for claims, benefits, and other questions.
After performing a Claim Status Search, specific denial reasons will be shown for each denied claim line in Claim Status Details. Denial messages corresponding to the claim line number will be displayed directly above the Claim and Service Line Details.
You may check the status of your NaviNet registration at any time from the Registration Page or Help Center.
If a provider’s registration information is accurate, complete, and matches the information we have on file, the NaviNet registration process should take five to seven business days. If anything does not match, NaviNet will attempt to reach the provider by phone for clarification.
Upon initial enrollment, you will get an acknowledgment email from enrollment@navinet.net. Once confirmed, you will get another email with login information and next steps.
Visit the NantHealth Help Center to register as a third party with NaviNet and follow the steps on the page.
If there are questions or concerns regarding member eligibility and claim status, please reach out to our Customer Service department at 800-635-0579.
For questions regarding logging in, access, setting up new users, or navigating the website, please reach out to NaviNet directly at 888-482-8057.
Medicare Advantage FAQs
All MA plans are not the same. Each MA plan is customized by private health insurance companies and follow guidelines provided by the federal government. Most MA plans offer benefits beyond Original Medicare.
Many MA plans have low out-of-pocket costs and premiums. In many plans, hospitals and providers are paid the same as Original Medicare. MA plans place an emphasis on preventive care and include many benefits not offered by Original Medicare, which have been shown to improve the health and well-being of MA members compared to Original Medicare.
Many MA plans provide care using networks of providers and specialists, but all networks are not equal. PPO MA plans allow you to use doctors, hospitals and other health care providers outside the network without a referral.
Many MA plans offer robust travel networks of providers allowing flexibility across the country.
Original Medicare does not pay for the entire cost of care, so costs are passed to the beneficiary. Many MA plans include predictable cost-share amounts in the form of copays or coinsurance for covered Medicare services, which are applicable toward an annual maximum out-of-pocket amount. Original Medicare does not offer the same financial protection.
MA plan benefits can change annually. The Annual Enrollment Period (AEP), which runs from Oct. 15 to Dec. 7 each year, is an opportunity for Medicare beneficiaries to evaluate their plan and determine if changes are necessary for the upcoming year.
Again, not all MA plans are created equal. Many MA plans do not require referrals to see specialists. MA plans may require prior authorization for some services to ensure the care is medically necessary and the proper payments are made. Many of these controls do not exist in Original Medicare, making health care more expensive overall.
Claims FAQs
- Obstetrical (OB) claim, total OB care
- Fraud, waste, abuse, or intentional misconduct
- Not obtaining a member identification card: For exception consideration, providers must produce written documentation, obtained at the time of service, and signed by the member, indicating that the member does not have insurance. Proof of attempts to obtain insurance information from the member within the timely filing period will be considered at the discretion of BCBSNE. Documentation must be submitted to BCBSNE within 12 months of the date of service. In addition, if a member provides insurance other than BCBS insurance and you receive notification from that insurance the BCBS is primary, this is considered a COB situation and should be submitted on a reconsideration with the primary recoupment or denial. Do not send as a timely filing because these are being returned to you and delaying your ability to have the claim processed correctly.
If a claim is listed on a BCBSNE-accepted claim report and shows no errors but was not processed or returned, we will reconsider the timely filing rejection and process the claim.
Include the page from the clearinghouse report showing both the clearinghouse and BCBSNE accepted the claim without errors (this must be included, or the request will not be considered).
- To submit a timely filing dispute via NaviNet, please go to your claim status details, click on the
button, and select the type and reason for your request. You can add free-form text, attach any supporting documentation (in PDF format), and submit the request. - Claim Timely Filing Disputes can take up to 30 days for review. You will receive a response via email from ProviderExecs@NebraskaBlue.com.
If other carrier information needs to be reviewed, please use the Reconsideration Form. This should be submitted via NaviNet® for the following requests:
- Coordination of benefits: timely filing is 120 days from the date on the primary payor’s EOB, which must be included.
- Worker’s compensation: timely filing is 120 days from the date on the worker’s compensation carrier letter, which must be included.
Member/patient provides insurance other than BCBS insurance and you receive notification from that insurance the BCBS is primary, this is considered a COB situation. Do not send as a timely filing because these are being returned to you and delaying your ability to have the claim processed correctly.
Professional (including Medicare Advantage): 77780
Institutional (including Medicare Advantage): 00260
Dental: 00760
Third party billing software can be used to submit claims electronically; however, appropriate testing must be done beforehand to ensure no problems will arise during claim submission.
For providers that want to submit claims directly to BCBSNE, but do not already have billing software, BCBSNE does offer free software support with PC-ACE. This will require a Windows computer as it is not compatible with Macs. Please be aware we will not offer support or access to our version of PC-ACE to providers who will not be using it to submit claims directly to BCBSNE. Please contact ProviderServicesOperationsSupport@NebraskaBlue.com if you are interested in looking at PC-ACE as an option.
Ensure 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; it will not be returned and could impact claim processing.
We appreciate you working with your vendors to ensure they understand this contractual arrangement to submit the requested records on your behalf without delay or request for payment. If there is anything we can do to make this process easier for you, please let us know.
Beginning March 16, 2020, when submitting a claim, the correct provider taxonomy must be on the claim for it to process. This is the taxonomy you were credentialed with and could be different from NPPES.
What is provider taxonomy? Provider taxonomy is a set of 10 alphanumeric characters that define specific specialty categories for providers (individual, group, or institution). There are different levels defined in the code set, including Provider Grouping, Classification and Area of Specialization. Providers may identify under more than one code set.
How does this affect you? Please ensure you are submitting the correct taxonomy. This information is needed for credentialing, delegated updates, and claims processing. It is important that the taxonomy matches the credentialed taxonomy on file with BCBSNE. When the appropriate information is not submitted, the claim will be returned.
For newly credentialed providers, please reference your letter with effective date and taxonomy code listed. An excellent source for more information on taxonomy is www.nucc.org.
Only clearinghouses approved to be trading partners with BCBSNE can submit claims electronically. Your clearinghouse should be able to advise you if they are already a trading partner with BCBSNE. If you have a clearinghouse that is not a trading partner with BCBSNE, have them contact ProviderServicesOperationsSupport@NebraskaBlue.com for more information on how to become a trading partner.
For a provider to be set up with Electronic Remittance Advice (ERA), the provider or clearinghouse needs to submit the ERA Form. If the provider is filling out the form they will need to get the trading partner number from their clearinghouse.
BCBSNE offers daily validation reports (TA1, 999, and Claim Confirmation Report) for electronic claims submitted directly. Please contact your vendor to request access to these reports if you submit claims through a clearinghouse.
- Duplicate claim being found already in the system.
- Medicare primary claims cannot be accepted until 30 days from the adjudication date have passed. If claims are submitted before the 30 days has passed, the claim will reject.
- Billing Tax ID not found – If this error message displays make sure the Tax ID submitted on the claim is correct and the rendering provider’s National Provider Indicator (NPI) is also correct.
- Taxonomy code is required on all claims or the claim will reject.
- Membership issues – Make sure that the patient/subscriber name is spelled correctly and that the Member ID is the correct and current one.
Yes, all claims should have the NPI number. A provider’s individual NPI number must be submitted under the rendering section on professional and dental claims if separate from the clinic’s NPI.
Is a taxonomy code required on all claims?
Beginning March 16, 2020, when submitting a claim, the correct provider taxonomy must be on the claim for it to process. This is the taxonomy you were credentialed with and could be different from NPPES.
What is provider taxonomy? Provider taxonomy is a set of 10 alphanumeric characters that define specific specialty categories for providers (individual, group, or institution). There are different levels defined in the code set, including Provider Grouping, Classification and Area of Specialization. Providers may identify under more than one code set.
How does this affect you? Please ensure you are submitting the correct taxonomy. This information is needed for credentialing, delegated updates, and claims processing. It is important that the taxonomy matches the credentialed taxonomy on file with BCBSNE. When the appropriate information is not submitted, the claim will be returned.
For newly credentialed providers, please reference your letter with effective date and taxonomy code listed. An excellent source for more information on taxonomy is www.nucc.org.
If a claim hit an upfront rejection that appears on the validation reports or you received a return letter, the claim can simply be corrected per the error message and be re-submitted.
If a claim passed into our system with no errors and adjudicated, it will need to be submitted as a corrected claim.
BCBSNE requires that a claim sent electronically must also be submitted electronically as a corrected claim. When creating the corrected 837 file, place a value of 5, 7 or 8 (Late Charge Only, Replacement of Prior Claim, Void/Cancel of a Prior Claim) in the 2300 CLM 05-3 (Claim Frequency Code) element as appropriate for the provider. Enter the original claim number assigned by BCBSNE in the 2300 REF*F8 segment. Looking at the form, these sections would correspond with box 22 for professional or box 4 on an institutional claim.
If an attachment is needed the claim, should be dropped to paper and filled out with a reconsideration form.
We discovered a scenario where the Rendering Provider is provided on the EDI at 2310B loop and 2420A loop. If the 2420A loop is being sent, please ensure the taxonomy is included in that loop. There may be future edits where if loop 2420A is utilized but the Rendering taxonomy is not included, this could cause claims to reject.
Per the ANSI Guide for 837P claims, it appears that 2420A is Situational and is only required when the Rendering Provider is different than what has been provided in 2310B (which is not the case on any of our claims) and that 2420A is meant to override the information in the claim-level segment (2310B).
- LIN (Drug Identification) Segment usage
LIN02 = N4 qualifier for NDC Drug Code
LIN03 = NDC code in 5-4-2 format.
Sample: LIN**N4*01234567891~
Please see the Professional Addenda and the Institutional Addenda for additional usage information.
- CPT (Drug Pricing) Segment usage
CTP04 = Quantity
CTP05-1 = Unit of Measurement Code values (see below for available list)
F2 International Unit
GR Gram
ML Milliliter
UN Unit
Sample: CTP*****2*UN~
Please see the Professional Addenda and the Institutional Addenda for additional usage information.
We have adjusted our process to ensure allowed amounts are reflected on the 835s. Providers should see this change reflected on the 835s moving forward.
We would like to bring awareness when BCBS is not the primary payer. When BCBS is secondary, the allowed amount displayed on the 835 reflects what is allowed AFTER the primary insurer processes the claim. Please see some examples below:
Example 1:
- Primary allows $100 and pays $85
- 835 will reflect $15 as the allowed amount ($100-$85 = $15)
Example 2:
- Primary allows $100 and pays $0
- BCBSNE allows $120 but 835 will reflect $100 as allowed amount of primary
Currently providers are receiving CO 45 (charges exceed contracted arrangement) remark code on remits. This is not a separate discount. Providers can ignore this code as they would receive the correct adjustment amounts from Medicare.
Providers or their vendors will need to fill out the ERA form. If the provider is filling out the form they will need to get the trading partner number from their clearinghouse.
Once the form is received, it is usually processed within 24 to 48 hours or on the next business day. If the "Check here to turn paper off immediately" box is not checked, paper remits will be turned off after 60 days to allow for adjustment to the transition. An email confirmation should be received after sign up. The first electronic remit should be received the week following sign up.
Medical: Remits begin to generate Tuesday nights.
For direct submitters/PC-ACE users, electronic remittance will be available online on BCBSNE's Secure File Transfer protocol website by Friday of each week, although they are normally viewable by Thursday. If it is Thursday and the remits are not yet available, please wait until Friday before reaching out to EDI Support to question whether the remit is missing.
For providers who receive ERA through a vendor or clearinghouse, please reach out to them to find out the delivery times expected. If a remit is missing or not delivered on time, please reach out to your clearinghouse first to verify if it is something in their system.
Dental: Remits begin to generate Thursday nights. For providers who receive ERA through a vendor or clearinghouse, please reach out to them to find out the delivery times expected. If a remit is missing or not delivered on time, please reach out to your clearinghouse first to verify if it is something in their system.
Direct submitters/PC-ACE users can receive their ERA directly from BCBSNE’s Secure File Transfer Protocol website for pickup each week.
Providers who use a vendor or clearinghouse for electronic claims can receive their remits through that clearinghouse via the ERA setup. BCBSNE will submit the electronic remits directly to the provider’s clearinghouse, who will be responsible for delivering to the provider.
This is a reminder that remits will be received by the Clearinghouses within 72 hours from the time of the weekly payment. Reminder, remittance information is available via NaviNet. If you are unable to retrieve your remittance advice after 72 hours, please check NaviNet and your clearinghouse, if applicable.
If you are unable to locate remits after using the steps above, please email your request to ProviderServicesOperationsSupport@nebraskablue.com. Our teams will research and follow-up within 10 business days.
Please include:
- Provider name, NPI, Tax ID
- Details on the payment
- Check number (if applicable)
- Check amount (if applicable)
- Date missing
- Contact information
Once the form has been submitted and processed, you should receive an email confirmation stating the setup has been completed and the effective date if not immediate. If no email confirmation is received, you can follow up by emailing ProviderServicesOperationsSupport@NebraskaBlue.com.
When an EFT deposit is made, it should still show the check number along with "BCBSNE;" this can be compared to the check number found on the remit. The amount of an EFT should also match with the total amount on the remit. You must work with your bank if you wish to be notified when EFTs are credited to your account.
After the 60-day transition period (for providers who did not choose to opt out of paper EOBs immediately), paper remits will not be sent.
On May 25, 2023, BCBSNE implemented a change in our mail processing. This change impacts the time it will take for providers not signed up for EFTS and ERAs to receive paper check payments and paper remits.
Previous Process:
- Checks and remits were received within 3-5 business days
New Process:
- Checks and remits will be received within 5-7 business days
As we continue to enhance our digital delivery channels, paper transactions will decrease. To get ahead of future transitions and avoid the extended time it will take to receive the check and remit, providers can sign up for EFTs and ERAs by completing the forms found on NaviNet and submitting to HealthNetworkRequests@NebraskaBlue.com.
- Electronic Funds Transfer (EFT)
- Electronic Remittance Advice (ERA)
If you have questions, please contact your Provider Executive.
PC-ACE software updates are issued quarterly and PC-ACE users are notified with the updated password via the email we have on file. As such, please keep us updated if you change your email address.
Did you know if you submit claims with your patient account number this available in NaviNet?
This is not a BCBSNE assigned number—this is the number from your EMR/records. Our CSC team will no longer provide this information instead we will direct you to NaviNet or to reference your own system.
CAQH Provider Portal FAQs
Providers will need to refer to NebraskaBlue.com/Providers/Credentialing for credentialing requirements. The initial credentialing and re-credentialing processes have not changed.
We do not currently utilize CAQH for other entities – just professionals/practitioners.
No. Providers still need to complete our Credentialing Requirements listed under our Credentialing Section.
Credentialing Information for Providers
Access is in CAQH under “Authorize”.
Effective dates are honored the date the request was received and or the date requested on the update.
We will not backdate.
Updates requested for future dates will go by the requested date.
Updates can be made by updating your CAQH Provider Profile and clicking "Review & Attest".
If there are no changes to be made, you will need to notify quarterly by confirming your practice locations and clicking "Review & Attest".
- Name
- Address
- Office Locations
- Phone and Fax Number for your specific practice
- Location
- Accepting New Patients
- Email Address
- Languages Spoken
- NPI
- Specialties
No email will be sent. You will need to refer to NebraskaBlue.com.
For example, a provider with Select Choice joins a TIN who does not yet have that contract. Are they still in network with Select? We rely on those approval letters to be certain.
When a provider extends to a new practice and that TIN is already is participating with BCBSNE, the practitioner will get added to that TIN and receive the networks that are already established under that TIN.
When a provider extends to a new practice and that TIN is not participating with BCBSNE, the provider data specialists will still handle the contracting the same as it today, by reaching out and getting the necessary agreements needed.
NaviNet Quarterly rosters are posted every 90 days and is the data that is currently in BCBSNE’s provider data system. If the provider terms in CAQH due to retiring or moving locations, the CAQH data will update our provider data system, and then when the next quarterly roster comes out on NaviNet, that provider should no longer be showing at that TIN if they termed.
Yes. Providers can archive a location. If you are archiving a location be sure to add your new or current location at the same time. Do not do this in separate requests.
At this time, that is correct.
Please ensure you are clicking "Review & Attest" after each update is made.
Updated every 90 days and is available to download via NaviNet
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