Provider Resources

Effective July 19, 2024, BCBSNE is not required to reimburse Medicare Supplement suppliers or beneficiaries for any durable medical equipment purchases greater than 115% of the Medicare-approved amount according to Legislative Bill 852 (LB852). Before receiving services, we encourage members to ask if their provider accepts Medicare or Medicare Assignment. If they do not, members may incur higher out-of-pocket costs.

View updates about these federal mandates and how the legislation may impact providers.

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Beginning Sept. 1, 2021, BCBSNE’s fully insured products will follow LB487 which allows for cost shares and reimbursement rates for covered telehealth behavioral health services to be the same as the in-person rates.

Effective Jan. 1, 2021, providers in Nebraska may not balance bill patients for medical care received from out-of-network providers or facilities in emergency situations. Legislative Bill 997 (LB997), also known as the Out-of-Network Emergency Medical Care Act, keeps consumers from getting surprise bills from out-of-network providers or facilities for medical emergency services. Facilities are defined as a general acute hospital, satellite emergency department or ambulatory surgical center licensed pursuant to the Health Care Facility Licensure Act.

This state mandate applies to all fully insured plans and non-ERISA groups.

Out-of-network providers will receive remits for these claims. Remits will display the M16 RARC message code which communicates the information below. 

Providers disputing the payment from BCBSNE may complete an LB997 - Out of Network Emergency Medical Care Act Reimbursement Dispute Request. 

Download the Dispute Request form »

What is the BlueCard Executive?
The BlueCard Executive is a designated senior-level individual at Blue Cross and Blue Shield of Nebraska who is accountable for resolving escalated issues regarding certain BlueCard claim payments. All other BlueCard issues must be addressed using existing dispute and/or appeals processes first.

Providers serviced by Blue Cross and Blue Shield of Nebraska can request eligible escalations by emailing Dana Medeiros.

Only members of the Provider MDL Settlement Class can engage the BlueCard Executive.

What claims can be escalated to the BlueCard Executive without first pursuing existing dispute and appeals processes?
BlueCard Executives can receive escalations for claims that meet the following criteria: 

• Open BlueCard claims aged forty-five calendar days or more from the submission date and billed charges of $1 million or more
• Open BlueCard claims aged sixty calendar days or more from the submission date and billed charges of $500,000 or more
• Open BlueCard claims aged ninety calendar days or more from the submission date and billed charges of $300,000 or more

How do I contact the BlueCard Executive?
You can contact your local Blue Plan’s BlueCard Executive by emailing Dana.Medeiros@NebraskaBlue.com.

If the claim in question requires information or assistance from another Blue Plan, your BlueCard Executive will coordinate with the other Plan to resolve the inquiry. 

For additional information on the settlement, visit www.bcbsprovidersettlement.com.

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Children’s Nebraska has launched a new multi-year effort to support Nebraska providers through the Children’s Outreach and Provider Education (COPE) program. COPE provides education, consultation, and resources so primary care providers can more comfortably identify, treat, and manage pediatric mental health conditions seen every day in their practices.

To learn more about this program, please visit: www.childrensnebraska.org/cope/

The resources shared in this section are for informational purposes only and are not binding to the reimbursement of BCBSNE claims. If you have questions regarding BCBSNE’s billing or reimbursement policies, please consult the BCBSNE Provider Procedures or contact your provider executive.

• BCBSNE does not cover PLA CPT® codes submitted by providers not identified as approved laboratories by the American Medical Association (AMA):  FAQ: CPT® PLA | American Medical Association (ama-assn.org)
• National Correct Coding Initiative (NCCI) Edits, Including Medically Unlikely Edits (MUEs) and Procedure-to-Procedure (PTP) Code Pair Edits:
  https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd
• Medicare Learning Network (MLN):
  https://www.cms.gov/training-education/medicare-learning-networkr-mln/resources-training
• CMS Evaluation and Management (E/M) Services Guide:
  https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/eval-mgmt-serv-guide-ICN006764.pdf
• CMS Newsroom and Subscription Sign Up
  https://www.cms.gov/newsroom

BCBSNE is proud to support NMA’s peer-to-peer physician coaching program, LifeBridge Nebraska.

To learn more and to view coach profiles, please visit LifeBridgeNebraska.org.

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