Provider Claims Inquiry

For the quickest, most accurate response, please fill in as much information as possible. We will respond to you by e-mail. (* denotes required fields). Please allow up to 5 business days for a response.

*Inquiry Class Type
*Inquiry Type:
*Your First Name:
*Your Last Name:
*Your Phone Number:  ext
 
* Your Email Address:

Subscriber and Patient Information

Federal Employee:
*Prefix/ID Number: -

The patient's Blue Cross and Blue Shield of Nebraska identification number (including the three-letter alpha-prefix) is located on the front of their ID card.
 

*Subscriber First Name:
*Subscriber Last Name:
* Patient First Name:
* Patient Last Name:
* Patient Date of Birth:

Physician

*NPI:
*Last Name or Facility Name:
First Name:

Claim

*Claim Number:
*Billed Charges:
*Dates of Services:  to 
*Question:

Please note that if the patient is a member of an out-of-area Blue Cross Blue Shield plan, your claims, appeals and reconsiderations may take longer than 60 days due to coordination with other Blues plans.