Why BCBSNE is moving to HealthRules

As with any business, employers continue to look to improve processes and make their business more efficient. BCBSNE is no different.

After a thorough review, we have determined that HealthRules will be able to deliver those improvements and efficiencies for our groups. The move from our current platform (CoreLink) to HealthRules will help us deliver a better member experience.

HealthRules Transition Toolkit

Equip your employees with the tools they need for the transition to the new HealthRules system. Simply choose your toolkit (with information on telehealth or without), download the toolkit items and insert your group’s HealthRules transition date where applicable within each piece.

Changes for Employees

Member ID Card: New ID cards will have the same look, but will have new information, such as a new prefix, ID number and customer service telephone number. Members must provide their new card to their doctor, pharmacy or health care facility or the claim processing may be delayed.

Schedule of Benefits: The Schedule of Benefits, mailed with ID cards, has a simplified look that makes it easier to read and understand the key cost shares.

Explanation of Benefits (EOB): New EOBs, with a clearer layout, will be issued as groups transition. Current EOBs will continue to be used for members on CoreLink. People may see both versions as claims with incurred dates prior to the transition are still processed on CoreLink.

Coordination of Benefits (COB): In order to make sure that we have our members' most current primary and secondary health coverage information, BCBSNE will be sending the new COB questionnaire to them.

Pharmacy COB: When we are secondary, COB determination will now occur at the pharmacy, at the time prescriptions are filled. In most cases, members will no longer need to submit paper claims for secondary coverage.

myNebraskaBlue: Members will have access to old and new ID cards in their myNebraskaBlue account and can view new and previous claims data.

Telehealth: Members who have registered for telehealth will need to login and update their information to reflect their new member ID number.

Employee Communication Materials: BCBSNE will provide helpful assets to educate employees upon renewal. These resources will enable employers to communicate important information about the transition, and will include employee emails, fliers, posters, table tents and intranet content.

Welcome Packet: A new member packet will be mailed to new members of existing groups and members of new groups when they first enroll. The packet will include member ID cards, a welcome letter, the Schedule of Benefits and the Get Started guide.

Changes for Employer Groups

Account/Group Structure: Current group numbers and group roll numbers will change to a simplified account structure. Mapping existing group numbers and new numbers will be provided prior to the transition to HealthRules.

Enrollment Files

Benefitfocus/BluesEnrolls: The account/group structure crosswalk will be used to support the transition and set up of member eligibility.

Once a group has transitioned to HealthRules, both previous (CoreLink) and present (HealthRules) enrollment data will be available.

e-Exchange: No changes are anticipated.

Self-funded Clients: Self-funded clients will no longer be required to submit documentation to validate the accuracy of their enrollment files. The exception to this rule is for adjustments greater than 60 days.

For self-funded clients with stop loss coverage through BCBSNE or one of our preferred stop loss carriers, validation to confirm eligibility will be requested when the member reaches their specific stop loss limit and/or when the plan reaches the aggregate limits.

Premium Billing Statement for Fully Insured

BluePride and BlueFreedom: The billing cycle will move to the 16th of the month.

PremierBlue/Large group: Will continue to bill on the 20th of the month.

Reporting: Multi-year reporting will be supported with the ability to integrate data from both the CoreLink and HealthRules systems through the Insight Analytics tool.

Contact a member of Blue Cross and Blue Shield of Nebraska Sales or Account Management Team for more information.