Happening Now

For ease of access, we have created a COVID-19 page which will be your source for updates during this pandemic. View COVID-19 updates » 

 

 

Beginning March 1, 2021 ANY corrected claims submitted with a recon will be returned. Corrected claims should be submitted electronically.

If they cannot be submitted electronically because your claim will include attachments, you must file your corrected paper claim to BCBSNE with the attachments, do not submit corrected claims using a reconsideration form, it will be returned.

More information can be found in section 8 of our General P&P. 

BCBSNE advised providers to submit telehealth claims using place of service 02 and modifier 95 with the appropriate CPT codes.  

Telemedicine claims should follow the specific guidelines below which can also be found in our General P&P. Claims for telemedicine (claims with CPT 99205 or 99215 for example) billed with POS 02 and modifier 95 will be returned as this is not appropriate billing for telemedicine.  BCBSNE would advise working with your coding and billing teams to submit claims with correct POS and modifier if ALL OF THE CONDITIONS are met for telemedicine.

There is a possibility some claims may have been processed in error, however, the telemedicine policy has not changed.

Telemedicine policy screenshot
The below codes are the only applicable telehealth codes that should be billed with POS 02 and modifier 95.  

Telehealth codes sample screenshot

BCBSNE Response to LB997
Out-of-network providers in Nebraska may no longer balance bill patients for medical care received from facilities in emergency situations. The recently-passed Legislative Bill 997 (LB997) also known as the Out-of-Network Emergency Medical Care Act, keeps consumers from receiving surprise bills from out-of-network providers or facilities for medical emergencies.

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

M16 Alert

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 »

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

Non-Nebraska 835s Now Available on NaviNet
Great news! BCBSNE has completed the work which enables non-Nebraska 835s to now be available on NaviNet

Previously, providers would contact our EDI team inquiring about missing 835s in NaviNet, the vast majority was due to 835s only being sent to the members plan. 

Beginning with 835s sent out this week, a copy of each 835 was also sent NaviNet.

Specialty Intraocular Lenses
Effective March 1, 2021, BCBSNE has made a change to the coverage of the new technology IOLs.  Please watch for the December 18th update to the Billing and Reimbursement Policies and Procedures for more specific information.   

In 2019, certain vaccine codes began requiring NDC numbers for pricing. The NDC number allows BCBSNE to provide better reimbursement for providers.

In July 2020, additional vaccine codes in the 90281-90749 range were added to this requirement.

Claims that are returned for needing an NDC number will need to be resubmitted with the appropriate NDC number.

NOTE: Admin codes of 90460, 90461 and 90471-90474 do not require an NDC number.

Blue Cross and Blue Shield of Nebraska continues to work on improving the tools available to our providers. The following can now be obtained for non-Nebraska BCBS members:

  • Accurate claim status 
  • Correct claim ID
  • Applicable check number/EFT with working remit link

You will notice changes to the recoupment initiation notifications and recoupment offsets displayed in your 835s and EOPs. Changes include the following:

Changes to 835 and EOP:
  • Recoupment offsets will display immediately
  • Recoupment offsets will not happen for a minimum of 30 days after notification
  • When money is deducted from a future payment; it will be important to reference the previous 835/EOP for details. See the Provider Level Adjustments for more information »
  • Once a claim has been adjusted/voided, the adjustment/void and the offsetting of the recoupment will be reflected in the next 835 and/or EOP
New for HealthRules:
  • FEP claims will offset immediately
  • Partial recoupments
  • Dental recoupments
Guide to Understanding the Adjustments
Notes include:
  • Where to find the adjustments on the claim
  • An example of the new change where positives become negatives and negatives become positives
  • How to tell if the adjustment affects the claim
  • An example of a message indicating the amount retracted from the adjusted claim

Questions? Reach out to your Provider Executive Team »

For all inpatient* and professional claims that occur at the end of one year and continue into the next year, charges incurred during each year must be submitted on separate claims. 

This requirement takes effect with claims that span from 2020-2021.

For example:

If dates of service are from 12/15/2020 to 1/15/2021:

  • Submit charges incurred from 12/15/2020 – 12/31/2020 on one claim
  • Submit charges incurred from 1/1/2021 – 1/15/2021 on a separate claim

Claims that are submitted with charges incurred during both years on the same claim will result in processing delays. 

Split billing of charges that span from one year to the next is highly recommended.  Claims that are split could result in auto-adjudication and/or faster processing times.

*Inpatient includes:  acute care hospital, psychiatric hospital, rehabilitation hospital, skilled nursing and swing-bed

BCBSNE will accept claims with an observation line item greater than 48 hours to allow for accurate documentation; however, charges in excess of 48 hours will be denied as content.

Example
  • 52 hours OBS submitted (on one line)
  • 48 hours paid
  • 4 hours were included as content

BCBSNE recently re-activated upfront edits which will allow claims missing or needing additional information to show on your clearinghouse rejection reports.

We have heard from you in several conversations that waiting on return letters is not efficient. This change will allow claims to stop “at the door” and corrections to be made without the delay of waiting for a return letter.

We anticipate this will begin happening by October 12.

Edit Number Edit Description
32152 Subscriber name missing/misspelling
32153  Patient not on file/DOB doesn't match
32156 No coverage for medical services
32157 No coverage for dental services
32158 Billing Tax ID not found
32160 Provider not active under Tax ID/NPI for DOS
32199 Duplicate claim found
32523 HME procedure requires 'RR' or 'NU' modifier
32524 HME rental requires a valid service through date
32576 Code 32576 (blood sugar CPT) requires category code
Last week, we advised allowed amounts would once again be on the 835s. This was GREAT news. Today we are excited to announce the testing is complete and phase two was a success!

The Patient Account Number along with the Claim ID on the PLB2 field will be reflected with this weeks 835s. 

The format is PLB*[Provider NPI]*[Fiscal Year End Date]*FB:[Patient Account Number][ Claim ID]*[Amount]~
2 Examples
PLB*1881632883*20201231*WO:810931238700 20191400000199*225.01~
PLB*1881632883*20201231*FB:T1214763 20191300000246*-102.99~
We want to thank our providers for the suggestions on how to make it easier to read the PLB sections of the 835. Both of these changes are a result of our conversations with you.

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

Please find up-to-date timelines on BCBSNE's NaviNet home page.

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.

BCBSNE introduced the requirement for taxonomy codes on electronic claims in 2019. Our May UPDATE provided additional information. Beginning March 16, 2020, we will require both electronic and paper claims to be submitted with the taxonomy code.

Currently, our system is rejecting electronic claims missing the taxonomy code, but we have been processing paper claims. Beginning Monday, March 16, 2020, we will also return paper claims. Making this change will allow us to process claims more efficiently.

For additional information, please see Claims FAQs »

When a corrected claim is submitted, the billed amount for the corrected claims will be the same as the original billed amount on the remits and EOBs. BCBSNE will correct the claim as submitted by the provider, this will reflect in the allowed amount and the paid amount. The billed amount will always reflect the original claim amount.

For the Explanation of Payments (EOPs) that have multiple pages, it is possible the message code description is missing.
Download code descriptions »
Download FEP code descriptions »

**Some codes have multiple descriptions, please review the EOP in question and determine what description is most applicable for the code in question.

Until further notice, all 271 transactions will return the alpha prefix that is submitted on the 270 transactions. Please reference the member ID card for the current alpha prefix to be used for claims submissions.

Provider Resources

Centers for Medicare and Medicaid Services

Place of Service Codes
CMS ABN

Nebraska Medical Association (NMA)

The NMA is excited to announce the launch of their peer-to-peer physician coaching program LifeBridge Nebraska.

To learn more and to view coach profiles, please visit nebmed.org/lifebridge.

Coding and Billing

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 Policies and Procedures Manuals or contact your provider executive.