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 »

Retroactive changes
Due to the ever-changing status of COVID-19, BCBSNE will research and make retroactive changes to claims on your behalf as we adjust our policies.

Allowed Amounts on the 835 and Additions to the PLB Segments

Updated September 25, 2020

We have heard from our providers and have TWO exciting “adds” to the 835.

First – We have adjusted our process to ensure allowed amounts are reflected on the 835s.  Providers should see this change reflected on the 835s this week and 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

Second, we are in the final stages of adding the Patient Account Number along with the Claim ID on the PLB2 field. We anticipate this change will be “live” in October. 

Below, the NEW information providers will see is indicated in yellow.  This is the Patient Account Number from the corresponding claim (in blue).  If there was no Patient Account Number on the claim, there will only be the Claim ID. 

  • The format is PLB*[Provider NPI]*[Fiscal Year End Date]*FB:[Patient Account Number][ Claim ID]*[Amount]~
  • 2 Examples

1. PLB*1881632883*20201231*WO:810931238700 20191400000199*225.01~

2. PLB*1881632883*20201231*FB:T1214763 20191300000246*-102.99~

Vaccines and NDC Numbers

Updated September 10, 2020

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.

Corrected claim, Adjustment and Reconsideration Information

Updated August 25, 2020

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

OA16 Denials and the N350 Remark Code

Updated August 14, 2020

What is the issue? Claims that were originally denied with an OA16 or CO16 denial code have been reprocessed with an informational adjustment. However, some of these codes were replaced with an N350 remark code: Missing/Incomplete/Invalid Description of service for a Not Otherwise Classified (NOC) code or for an unlisted/by report procedure.

What members does this impact? Non-Nebraska members.

When will the claims be processed? Claims denied with N350 are currently in review.

Please continue to watch Happening Now and/or the bi-weekly Provider Executive Friday emails for more information. Please do not reach out to Customer Service or your Provider Executive until mid-September as information is not yet available.

Bilateral Surgery Claims

Updated July 10, 2020

BCBSNE has identified an issue with the new bilateral surgical claims process.  We have a solution to correct this and it is scheduled to be implemented mid-September.

To avoid delay in processing, all bilateral surgery claims will be manually reviewed and processed.  Once the automated fix is complete, we will conduct an internal audit to validate accurate payments were made.  If any discrepancies are found from the audit, we will reprocess those claims to apply correct pricing.  We apologize for the inconvenience this causes.

Please continue to watch Happening Now as well as the weekly emails from your Provider Executive for updates.  

Medicare Supplement CO 45 Remark Code

Updated April 24, 2020

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.

Corrected Claim Submission

Updated April 23, 2020

When a corrected claim is submitted, please do not add a suffix “00” to the end of the claim number. Our new system, HealthRules, rejects any claim numbers longer than 14 positions. Adding a suffix to the claim number results in 16 positions.

Locating EFTs/Checks on NaviNet

Updated Mar. 20, 2020

NaviNet has two dropdowns:
  • Billing Provider, which is required
  • Servicing Provider, which is optional

To see all EFTs/Check associated with the billing provider, do not select an option on the Servicing Provider dropdown.  

EFT drop down

Taxonomy Required on All Claims

Updated Mar. 13, 2020

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 »

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

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.

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 »