Happening Now

Medicare Crossover Claims

Updated Jan. 15, 2020

BCBSNE was recently notified of a technical challenge in receiving Medicare Crossover claims from the Centers for Medicare & Medicaid Services (CMS). To ensure that BCBSNE receives all Medicare Supplement claims for your patients, please be advised:

  • After claims have been processed by Medicare, please attach the Medicare processed EOB to the claim
  • Submit claims directly to BCBSNE – this is for any Medicare Supplement claims with dates of service Jan. 1 - Feb. 3, 2020
  • BCBSNE will process the Medicare Supplement portion

We have been notified that this issue will be resolved after Feb. 3, 2020 and claims should cross over directly from Medicare. Should this date change, please watch here for updates. We appreciate your patience and assistance as we work through this technical difficulty with CMS.

Claims System Transition

Updated Jan. 08, 2020

We have successfully transitioned all lines of business to our new HealthRules system. HealthRules provides a next-generation core administration system for health plans which allows for improved efficiencies in administration.

As we begin processing ALL claims in HealthRules our continued goal is to minimize disruption to our customers.

We encourage your continued use of our self-service tools including NaviNet, MedPolicy Blue, IVR and Claims Inquiry located on our eligibility and claims page.

Member ID Cards

New ID cards have been issued with updated information, such as a new prefix, ID number and customer service telephone number. Members must provide their new card to their doctor, pharmacy or facility.

new member ID card

Plan Codes
The plan code on the front of the ID card will change when the plan has moved to HealthRules.
New Plan Code: 259/759
Previous Plan Code: 263/763
Offsetting
HealthRules will offset Dental Claims. FEP will take immediate offsetting for CareFirst and other FEP claims.
Payment Cycles
Please see below for updated payment cycles.
Plan Codes Payment and remit distribution
ALL PLANS Tuesday and last business day of the month

Blue Card and Out of State Member Claims Questions

Updated Jan. 08, 2020

Please be aware claims questions for dates of service January 1, 2020, and after for Blue Card, Out of State (non-Nebraska), members must go through our email inquiry system.

We expect all servicing channels to be available by February 2020 – please continue to watch Happening Now for updates.

Submit a claims inquiry »

Remit/EOP Timing

Updated Jan. 8, 2019

Previously, remits and EOPs were received simultaneously with payments. In our new system, HealthRules, this will not always be the case. Typically, remits will be received 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

Members Effective Jan. 1, 2020

Updated Dec. 13, 2019

BCBSNE ID cards are being issued throughout the months of November and December for effective dates of 1/1/2020. There will be an issue date on the card. This date is NOT an effective date.

Please be sure to verify eligibility and benefits for all BCBSNE members using  NaviNet or our  Benefits Inquiry tools.

Any claims submitted under the new number will receive a message to submit under the current ID number.

Corrected Claims

Updated Dec. 13, 2019

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.

Dental EOP Message Codes

Updated Oct. 17, 2019

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.

270/271 Transactions

Updated Oct. 08, 2019

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.

Copayment Discrepancy

Updated July 9, 2019

For members whose plan has migrated to our new system Health Rules, we have identified a communication gap regarding the copayment displaying in Navinet. The copayment information displaying is not accurate. For copayment amounts, the member should refer to their benefits or contact Customer Service.

Providers should use IVR or can call Customer Service to obtain accurate copayment amounts for those plans on HealthRules. To know which plans have migrated, please refer to the plan code on the ID card.

Plan Codes
The plan code on the front of the ID card will change when the plan has moved to HealthRules.
Current Plan Code: 263/763
New Plan Code: 259/759

Please be sure to enter the correct ID number from the members' card as the ID numbers have changed once migrated.

Recoupment

Updated May 31, 2019

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 be reflected 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
  • 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
  • Payment Impact = True
    • The financial impact is realized on this RA
  • Payment Impact = False
    • The financial impact is realized on future RA
  • Reversals will no longer be seen on the recoupment claim run since this was communicated when the recoupment was initiated
  • The received payment amount will only reflect in the 835 when claims have been adjusted and the payment is applied to the receivable within the same payment cycle.
  • On the paper remit (EOP) when recoupment is offset against from a subsequent payment run you will see a recoupment amount listed next to the corresponding claim number as well as the total recoupments and the net payment
  • When the receivable is reported on the current payment is recouped against itself in the same payment, the final claim will include an extract message representing the change in payment amount but not recoupment details
Adjustments/Voids:
  • The claim being voided will reflect as a reversal of the original 835 that was generated for that claim payment
  • That void will appear as the exact opposite of the original 835
    • Each line amount and the count will be shown with the opposite amounts (positives will become negatives and negatives will become positives)
    • Since there will be no net change in the check payment, the net reversal to the paid amount will also be reflected in a check level Provider Adjustment (PLB) segment with a qualifier of Forwarding Balance (FB) for a negative adjustment
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 »