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Providers

Administrative Updates

In this section, you will find instructions and forms to update your demographic and practice data. Keeping your data up to date ensures accuracy for claims processing and provider directories. Please notify us of any changes at least 45 calendar days before they are effective to reduce impacts to claim processing and the need for potential claim adjustments.

If you are participating in a Physician-Hospital Organization (PHO), please contact your PHO representative to report your changes.

Providers not credentialed with Blue Cross and Blue Shield of Nebraska (BCBSNE) should please refer to Credentialing Requirements for information on the application process.

Click on the hyperlinked form names below to open each PDF.

TIP: If you are unable to see the PDFs, please read tips from Adobe Reader or follow the steps below to download them.

Please make sure you are sending accurate and complete information. If there is missing or incorrect information on the form(s), no further action will be taken; forms be returned indicating the corrections required or additional information needed, at which point they must be resubmitted and addressed in the order received. For corrections to previously submitted forms, please indicate which form you are correcting and the date originally submitted.

You will receive an email confirmation when your request is received. The email will indicate how long to allow for changes and how to inquire about their status. You will also be notified via email when your request has been completed.

To download the forms:

  1. Right click on PDF name
  2. Select “Save target as” or “Save link asto save it to your device
  3. Open the file in this saved location.

Please note: Requests must include a voided check and/or bank letter to complete the validation process.

EFT information can be added or updated by completing the Electronic Funds Transfer Enrollment Request form.

To cancel your EFT enrollment, please send an email to ProviderServicesOperationsSupport@NebraskaBlue.com

Please allow up to 10 business days for completion of this process.

Email the form to ProviderServicesOperationsSupport@NebraskaBlue.com

You will receive an email confirmation when your request is received. The email will indicate how long to allow for changes and how to inquire about their status. You will also be notified via email when your request has been completed.

Learn more about Electronic Funds Transfer

The Electronic Remittance Advice Enrollment form is used to enable electronic remittance advice (835). You may also use the form to update your ERA information on file.

 

Please allow up to 10 business days for completion of this process. 

 

Email the form to ProviderServicesOperationsSupport@NebraskaBlue.com


You will receive an email confirmation when your request is received. The email will indicate how long to allow for changes and how to inquire about their status. You will also be notified via email when your request has been completed.

Please note: Registration is not required for providers using a clearinghouse.

The Trading Partner Registration form is required to conduct electronic business transactions directly with BCBSNE.   

Please allow up to 10 business days for completion of this process. 

Email the form to ProviderServicesOperationsSupport@NebraskaBlue.com


You will receive an email confirmation when your request is received. The email will indicate how long to allow for changes and how to inquire about their status. You will also be notified via email when your request has been completed.

Please note: This agreement is not required for providers using a clearinghouse.

The Trading Partner Agreement is a HIPAA-required business associate agreement between BCBSNE and its trading partners. This agreement is a legally binding contract.

Email the form to ProviderServicesOperationsSupport@NebraskaBlue.com

You will receive an email confirmation when your request is received. The email will indicate how long to allow for changes and how to inquire about their status. You will also be notified via email when your request has been completed.

Please note: This form is for use by Nebraska providers only. If you are participating in a PHO, contact your PHO representative to report your changes. Requested effective dates cannot be prior to the date the form is submitted. If no effective date is given or an effective date is requested prior to the date the form is submitted, the assigned effective date will be the date the form was submitted.

Providers may use the Change of Address form to change an address and other demographics such as phone number, email and name (i.e., DBA). 

This form should only be used when keeping the same Tax ID. If you have a new Tax ID and need demographic information updated, please complete the Add/Extend/Transfer Form.

If you have multiple locations, please submit a form for each location. If you have more than 10 locations and need to make the same change for all locations, please complete the Provider Data Updates spreadsheet.

Please allow up to 60 days for completion of this process. After the change is made, please allow up to 24 hours for new information to be displayed in the Provider Finder.

Email the form and/or spreadsheet to HealthNetworkRequests@NebraskaBlue.com

You will receive an email confirmation when your request is received. The email will indicate how long to allow for changes and how to inquire about their status. You will also be notified via email when your request has been completed.

Please note: Completing this form will transfer all existing provider agreements. If the form is not signed and/or dated, it will be returned with no further action. Requested effective dates cannot be prior to the date the form is submitted. If no effective date is given or an effective date is requested prior to the date the form is submitted, the assigned effective date will be the date the form was submitted. 

The Provider Add/Extend/Transfer form is used to extend your BCBSNE network status to a new or additional location.

Providers participating in a PHO 
If the PHO handles your credentialing, please contact your PHO representative to report your changes.

If your credentialing is handled directly through BCBSNE, please proceed with completing the Provider Add/Extend/Transfer form.

Providers not participating in a PHO 
Please proceed with completing the Provider Add/Extend/Transfer form.

Providers not credentialed with BCBSNE 
Please refer to Credentialing Requirements for information on the application process. Facilities/Institutions must go through credentialing prior to adding a new location. Examples: durable medical equipment (DME), pharmacy, ambulatory surgical center (ASC), skilled nursing facility (SNF), hospital.

How do I notify you I’m leaving one location and moving to another?
If you are leaving your current location, and moving to a new location with a new tax ID, select TRANSFER on the form.  If you are moving to a new location but not changing tax IDs, please complete the  Change of Address form

How do I notify you when I’m adding a new Tax ID and keeping the old one, but the new Tax ID is not contracted yet?
Select the EXTEND option on the form. You will be sent an agreement to sign for the new Tax ID.  

How should I complete the form if I have multiple locations?
If you have multiple locations, please submit a form for each location. If you have more than 10 locations and need to make the same change for all locations, please complete the Provider Data Updates spreadsheet.

How do I join an additional network?
Please submit the request to your Provider Executive; contact information can be found at NebraskaBlue.com/Provider-Contacts. Please allow up to 60 days for completion of this process. After the change is made, please allow up to 24 hours for new information to be displayed in the Provider Finder.

Email the form to HealthNetworkRequests@NebraskaBlue.com

You will receive an email confirmation when your request is received. The email will indicate how long to allow for changes and how to inquire about their status. You will also be notified via email when your request has been completed.

Please note: This form is for use by PHMHP, PLADC, PLCSW, PPhD, PPsyD and RBT Nebraska providers only. Requested effective dates cannot be prior to the date the form is submitted. If no effective date is given or an effective date is requested prior to the date the form is submitted, the assigned effective date will be the date the form was submitted.

The Provisional Provider form is used to add a new provisionally-licensed behavioral health provider and report their supervising practioner's information. This form can also be used to update the supervising practioner's information for an existing provisional provider. 

To avoid claim impacts, please do not submit claims for the Provisional Provider until you have received notification the request has been completed. Claims submitted prior to the Provisional Provider being loaded may be processed as out of network or delayed. 

Please allow up to 60 days for completion of this process. 

Email the form to HealthNetworkRequests@NebraskaBlue.com

You will receive an email confirmation when your request is received. The email will indicate how long to allow for changes and how to inquire about their status. You will also be notified via email when your request has been completed.

The NPI Notification form is used to notify BCBSNE of your NPI number(s). This form may be used for your Individual (Type 1) or Organization (Type 2) NPI numbers.

Please allow up to 60 days for completion of this process.

Email the form to HealthNetworkRequests@NebraskaBlue.com

You will receive an email confirmation when your request is received. The email will indicate how long to allow for changes and how to inquire about their status. You will also be notified via email when your request has been completed.

Please note: BCBSNE should be notified immediately of all provider terminations. This will allow us to notify impacted members and ensure accurate information is displayed in the Provider Finder.

To terminate a provider or location, please send an email to HealthNetworkRequests@NebraskaBlue.com with the following information:

  • Provider name of the provider and/or practice terminating
  • Provider NPI
  • Tax ID
  • Address
  • Termination date (month/day/year)

If applicable, please also include the following:

  • If you wish to cease participating with BCBSNE at all of your locations. 
  • If your contract should be transferred to another group, please indicate which group you are working with so we may coordinate efforts.

For termination requests without a transfer notice to another group, BCBSNE will process the termination and send a letter to all members that have seen the provider in the last 18 months. This applies when the provider is no longer active under an existing agreement at any location.

For termination requests with a transfer notice to another group, BCBSNE will sync with both parties and process the transfer accordingly. A notification is not sent to members. This applies when the provider will remain active under an existing agreement at another location.

If claims were received after the requested termination date, you will be contacted to validate the termination date. We may request corrected claims are submitted. For additional information on submitting the claims, please refer to the General Policies and Procedures Manual.

Please allow up to 15 days for completion of this process. After the termination is processed, please allow up to 24 hours for updates to be displayed in the Provider Finder.