Happening Now

Please continue to watch Happening Now for updates.

Stay informed with the latest updates on Medicare Advantage plans.

Remittance Advices (RAs) no longer mailed in 2024 (March 26, 2024)

Beginning July 1, 2024, BCBSNE will no longer mail paper RAs to our participating network providers.

Providers will instead need to obtain ERAs from NaviNet or will need to sign up with a clearinghouse to receive 835s and enroll in our ERA service by clicking on Administrative Updates/Secure Forms link located on NaviNet.

Supporting our Provider Community impacted by Change Healthcare cyberattack (March 14, 2024)

BCBSNE knows the disruption to providers caused by the Change Healthcare cyberattack has been widespread and significant. 

While some offices and facilities have been able to switch clearinghouses and continue to submit claims for processing and reimbursement, others remain materially impacted by this ongoing situation.

We want to help. For those who are unable to submit claims due to the Change Healthcare situation, we are offering financial assistance—up to a four-week advance payment. 

Additionally, if there are other opportunities for us to help you and your teams bridge the gap during this disruption, we are here to partner with you.

Please contact your Blue Cross and Blue Shield of Nebraska provider relationship executive or email at ProviderExecs@NebraskaBlue.com with Advanced Payment Inquiry in the subject line.

Top three claim return reasons

To help providers submit accurate claims and take advantage of auto-adjudication, BCBSNE continues to rank the top three reasons for claim returns: 

 

  1. The provider’s name and credentials, Federal Tax Identification number and/or NPI are missing. 

    If the TIN or NPI have changed, refer to the Changes of address, telephone number and/or tax identification number, or adding practice locations policy. 

  2. The Federal Tax Identification number (TIN) and/or the NPI number for the Provider, Rendering or Referring, is not effective for the date of service.

    Please ensure you are submitting TIN/NPI of providers who are credentialed with BCBSNE. Most importantly, do not submit claims for newly-credentialed providers until you have the acceptance letter with the provider’s effective date.

    For credentialing guidance, please visit NebraskaBlue.com/Credentialing or the Administrative Updates/Secure Forms link on the BCBSNE NaviNet landing page.


  3. The required BCBS subscriber identification number is missing or invalid. 

    Please verify this information an resubmit your claim with the complete identification number as it appears on the member’s BCBS identification card in the correct ID number field.

    It is recommended that you photocopy the patient’s member ID card at every visit to ensure you have the most up-to-date coverage information.

    NebraskaBlue.com/Providers/Policies-and-Procedures/General/Identification-Cards

Claim Return, Reconsideration and Appeal letters are going paperless in 2024 (March 14, 2024)

Beginning Apr. 1, 2024, Blue Cross Blue Shield Nebraska will no longer mail claim return letters to our participating network health care professionals and facilities for BCBSNE plans.

Effective May 15, 2024, we will be adding Reconsideration and Appeal letters to this paperless process.


BCBSNE will instead post them on NaviNet under patient documents. There is an eLearning video for your reference by clicking here ➡️ eLearning - Provider Academy.

If you cannot locate the letter(s), please reach out using the Claims Investigation tool explaining what you did to locate the letter(s) and the issue you encountered.

BCBSNE has made the decision to transition away from Change Healthcare for Dental clearinghouse services. 

Vyne and DentalXchange clearinghouses are already set up with BCBSNE making the transition easier for you. BCBSNE continues taking steps to become paperless, it is important for our dental providers to align with a clearinghouse to both submit claims as well as receive remits. 

Below are the steps to take: 

Once you are connected, fill out the Electronic Remittance Advice Form available here: Find A Form and email completed forms to HealthNetworkRequests@NebraskaBlue.com.

Once the form is received the process can take up to 5 days. If you need further assistance or have additional questions, please reach out to our provider executive team at ProviderExecs@NebraskaBlue.com

You may receive requests from BCBSNE or BCBSNE vendors to review medical charts for your patients. As a participating provider, your contract requires you to permit BCBSNE and our business partners to inspect, review and obtain copies of such records upon request at no charge to BCBSNE or our members. 

We appreciate you working with your vendors to ensure they understand this contractual arrangement to submit the requested records on your behalf without delay or request for payment. If there is anything we can do to make this process easier for you, please let us know. 

Simply log in to NaviNet, perform a Claim Status Search, and look for the “Investigate” button at the top of your Claim Status Results page. For more information on the NaviNet Claim Investigation process, please visit: NaviNet:Quick Access.

If Customer Service was not successful in resolving your question/issue, you may contact ProviderExecs@NebraskaBlue.com. Please include your Claim Investigation inquiry or call reference number with a summary of your concern.

Federal Employee Plan (FEP) claims: The Claim Inquiry form was decommissioned on March 1, 2024. If your FEP claim is not available on NaviNet, please contact our FEP CSC Team for assistance at 402-390-1879 or 800-223-5584.

BCBSNE is making changes to the way our EAPG edits occur. When we initially implemented EAPGs, we realized with your input, there were unforeseen impacts by having NCCI edits coupled with EAPG edits that had NCCI built in. These were managed through different systems but had downstream impacts to the claims pricing.

We've acted over the past two years to make sure this is no longer occurring and have fixed our system edits. NCCI edits in addition to the EAPG edits are now appropriately pricing claims without the need for manual intervention.

The Change Health Care cyberattack that was identified on Feb. 22 has significantly impacted providers and payers. Since that date, BCBSNE has been focused on helping our provider community stay informed and aware of their options. We continue to update and offer providers guidance on Nebraska Blue via Happening Now. These updates have included:

  • We were able to quickly confirm our NaviNet authorization portal remained secure and providers are able to submit authorizations electronically
  • Providers were able to track status of all electronically submitted authorization via Navinet
  • Authorizations requiring a manual review have all been prioritized for response within committed response times
  • We provided a listing of alternative clearinghouses/trading partners available and already set up with BCBSNE for both our medical and dental provider communities
  • We "moved" files for 835 tracking from CHC to providers new clearinghouse
  • We responded with an “all hands-on deck” approach, expediting turn around times for providers submitting ERA forms

CHC Restoration:

We are closely monitoring the situation with Change Health Care. We are aware that Change Health Care is working toward re-establishing connections. Please know that we will work quickly—but cautiously—to restore our connections with Change Health Care once we have received third-party confirmation of the safety of those connections.

  • BCBSNE and our provider partners will need to reconnect to CHC for information to flow correctly and securely 
  • As best practice in the industry, we have requested and are expecting a third-party attestation to the safety of the CHC environments before we reconnect  
  • If your security/technical teams would like to discuss reconnection approaches, please let us know
  • With the extent that CHC provides services in the industry, there is a likelihood of downstream vendors restoration activities which could impact information flow and overall service restoration timelines

Continue to watch Happening Now and our Plan Central page on NaviNet for updates. 

On Jan. 1, 2024, the University of Nebraska employees and their dependents joined BCBSNE for their medical and/or dental coverage. These members have the prefix UNE, or YZL if their only coverage is dental. To prevent unnecessary delays in processing your claims, please ensure the date of service is on or after Jan. 1, 2024.  

Please see policy number DP-X-004 if you need guidance in submitting orthodontic claims.

 
 

Effective July 1, 2024, ASC Facilities will follow the same procedure as professional claims for Unlisted CPT/HCPC codes.  See policy number RP-X-008 for complete details. 

 
 
Are you planning on transitioning your clearing house? BCBSNE is here to support your change. Selecting one that is already set up with BCBSNE will make it easier.


Please fill out the Electronic Remittance Advice Form available here: Find A Form and email completed forms to HealthNetworkRequests@NebraskaBlue.com. With the current situation we will be expediting all requests received. Once the form is received the process can take 2-5 days.

The following list isn't all inclusive, but it does give you an idea of who we are currently using. 

  • Ability
  • AdvancedMD, Inc.
  • Allscripts Payerpath
  • Apex EDI
  • Associated Billing & Consulting
  • Availity LLC
  • CareTracker INC
  • CLAIM.MD
  • Cortex EDI Inc.
  • EDI Health Group / Dental Xchange
  • Eligible, Inc.
  • eProvider Solutions
  • eSolutions Inc.
  • Experian Health
  • Healthcare IP (Oliveai)
  • Infinedi, LLC
  • Office Ally, Inc
  • Phicure Next LLC
  • Quadax Inc.
  • RBS of Rowan, LLC
  • Rycan Technologies/Trubridge
  • The SSI Group
  • TKSoftware, Inc.
  • Trizetto Provider Solutions
  • ViaTrack Systems (Nextgen)
  • VVC Holding Corporation
  • Waystar
  • Zotec Partners LLC

For a complete list of trading partners please reach out to your provider relations representative or email ProviderExecs@NebraskaBlue.com.

For assistance on obtaining your previous 835s to your new trading partner please email ProviderServicesOperationsSupport@NebraskaBlue.com.

BCBSNE is aware of the cyber event impacting Change Healthcare. This is not a BCBSNE incident. Once we became aware of the incident, we disconnected our systems from Change Healthcare and will not reconnect until we have been approved through our security team.  

Providers who utilize Change Healthcare as a trading partner need to be aware of the following: 

  • 27x transactions are not being received
  • Claims are not being received by BCBSNE 
  • 835 and 837 files are also impacted  
  • Pharmacy fulfillment impacts 
  • Preauths can be submitted via NaviNet

This event has not directly affected our provider portal NaviNet. Please utilize NaviNet prior to contacting Customer Service. 

If at risk for timely filing, providers can submit paper claims. Please refer to the Policy and Procedures for additional claim submission info. Please allow 30 days for processing and accessing claim detail on NaviNet. Direct electronic submission of claims (such as batch loads) to BCBSNE are not possible at this time. 

Claim processing and payment detail, including remits, are available in NaviNet. For registration and/or NaviNet guidance please visit: NaviNet-Quick-Access as well as the Provider Academy

If you will be transitioning to another clearinghouse, please complete the “Electronic Remittance Advice Form” available here: Find A Form. Once the form is received the process can take 2-5 days. Please note we will need a completed ERA form for each TIN that is transitioning. 

Preauths should be submitted electronically via NaviNet. At this time, InterQual criteria is not available due to the CHC outage which will limit any automated approvals. Our internal authorization team is reviewing each request and following our response time agreements.

Please continue to watch Happening Now for updates. 

ProviderPortalAuthQuestions@NebraskaBlue.com email is no longer available.  Please see our eLearning video, NaviNet Preauthorization, for guidance in submitting and viewing preauthorization and precertification requests.  For additional tips and resources, please see our Preauthorization page.

 

As stated in our December 2023 Provider Bulletin BCBSNE will begin using the (Council for Affordable Quality Healthcare) CAQH directory solution, called DirectAssure. By submitting your updates in CAQH, you do not need to complete and email the BCBSNE Provider Add/Extend/Transfer, Change of Address and NPI forms for the 14 updates outlined in the article, Streamlining the Process for Provider Directory Updates.

For your convenience a link is available from our Providers page at Nebraska Blue to submit updates to CAQH.

Effective April 1, 2024, BCBSNE will no longer make updates from the forms. Changes must be submitted and attested to in CAQH. Attesting to your information replaces the requirement to review your provider directory information every 90-days in NaviNet.  

Please review our December 2023 Provider Bulletin for complete details and watch for upcoming issues of our Update Newsletter and Provider Bulletin for updates to this process.

DirectAssure is a provider directory solution that works with the Council for Affordable Quality Healthcare (CAQH) Provider Data Portal. ©2023 CAQH

Blue Cross and Blue Shield of Nebraska utilizes InterQual criteria for hospital inpatient admission reviews, and hospitals can submit precertification requests for admissions via our online portal by signing into NaviNet. Currently, acute inpatient admissions that meet InterQual criteria and do not pend for a BCBSNE nurse to review, receive an automatic approval of four days for the initial admission. 

Effective June 1, 2024, the initial length of stay automatically approved for acute inpatient admissions will be reduced from four days to three days. If additional days are needed, a concurrent review request is submitted via the online portal as it is today. The number of days automatically approved for observation admissions or concurrent reviews that meet the appropriate InterQual criteria will not change.

As we announced on Dec. 29, 2023, new enhanced denial messages are available in NaviNet. This new information is intended to save your office time when checking on claim status and avoid the need to contact Customer Service or claim investigations.

In NaviNet, after performing a Claim Status Search, specific denial messages will be shown for each denied claim line in Claim Status Details. Denial messages corresponding to the claim line number will be displayed directly above the Claim and Service Line Details. 

Our new Enhanced Claim Denials video is available in our Provider Academy eLearning library.

The enhanced messages will provide information needed to determine next steps on the claim denial and avoid the need to reach out to Customer Service. If you are unable to resolve your claim denial question, please refer to your billing/coding team before reaching out to Customer Service for assistance.  

Implemented on Feb. 6, 2024:

  • Inclusive/Included Denials: Claims denied inclusive will reference the claim number and CPT code the claim line denied inclusive to. Keep in mind, not all inclusive or included denials deny inclusive to another claim or CPT code. An example is non-billable charges. In this scenario, a message will still display advising the claim line denied inclusive, but it will not reference another claim or CPT code.
  • Duplicate Denials: NaviNet will advise what claim(s) the claim is denying as duplicate to. Keep in mind, if claim C denies duplicate to claim B, and claim B denies duplicate to claim A, claim C is going to show the claim # for claim B - not for the original claim A.
    • Exception: Non-Nebraska duplicate denials, as those are determined by the member’s plan.

Implemented on Feb. 13, 2024:

  • Reduction in payment denial: NaviNet will show when a payment reduction has been made and the claim number/CPT code to reference when a payment reduction has been made. BCBSNE expects providers to self-service when questioning why the full allowed amount was not used during claim’s processing rather than opening a claims investigation.
Federal Employee Plan (FEP) Claims questions can now be submitted via the Claims Investigation Feature in NaviNet. 

Simply log in to NaviNet, perform a Claim Status Search, and look for the “Investigate” button at the top of your Claim Status Results page. For more information on the NaviNet Claim Investigation process, please visit: NaviNet:Quick Access. If your FEP claim is not available on NaviNet, please contact our FEP CSC Team for assistance at 402-390-1879 or 800-223-5584.

Effective Jan. 1, 2024, we will no longer return the incorrectly filed requests. You will be responsible for correctly submitting the COB, workers’ compensation and subrogation adjustments.

Ensure you are using the reconsideration form for coordination of benefits (COB), workers’ compensation and subrogation adjustments instead of a timely filing override request.

If you are notified by another carrier that a member’s Blue Cross and Blue Shield (BCBS) insurance is primary, you should submit a reconsideration form with the primary recoupment or denial. Do not send a timely filing override request; it will not be returned and could impact claim processing.

When patient care extends into the new year, following our Split-Year Claim Submission policy ensures your claims are not rejected, returned or delayed due to billing errors.

If a provider obtained a prior authorization or retro authorization from the non-Nebraska Blues plan, but the claim has been denied as a Provider Sanction, please be advised:

  • Provider must submit a reconsideration via NaviNet
  • BCBSNE will send the reconsideration to the member’s plan for review
  • The member’s plan will determine if the claim will be reprocessed or if the denial is upheld
      

Newly enrolled members will have access to a digital temporary ID card in their myNebraskaBlue account. This ID card will only show the member ID number.

To verify benefits and eligibility, please log in to NaviNet or call our automated voice system at 800-635-0579.

ID Numbers for New Members
  

Effective Jan. 1, 2024, all City of Omaha members will move to the BCBSNE platform and prefix CKC. New ID cards have been issued to these City of Omaha members.

MedPolicy Blue preauthorization submissions will no longer be available beginning Feb. 1, 2024

Please use the preauthorization tool via NaviNet for submissions. MedPolicy Blue will still be available to access BCBSNE medical policies. 

Effective January 16, 2024, BCBSNE will begin using the (Council for Affordable Healthcare) CAQH directory solution, called DirectAssure. DirectAssure works with the CAQH Provider Data Portal, formerly known as CAQH ProView. 85% of in-network providers use CAQH today to submit their information and share it with multiple health plans. 

BCBSNE will automatically receive updates you submit in CAQH for the following items.

  • First, middle, and last name
  • Suffix
  • Office telephone number and extension
  • Fax number
  • Primary email address
  • Location adds and terminations
  • Gender
  • Date of birth
  • Languages spoken
  • Accepting new patients
  • NPI
  • Provider type
  • Primary practice indicator

By submitting the update in CAQH, you do not need to complete and email the BCBSNE Provider Add/Extend/Transfer, Change of Address, or NPI form. Demographic changes will be updated in the provider directory within 48-hours from submission. Please allow up to 30 days for taxonomy, NPI and provider type changes.

BCBSNE will receive notification of taxonomy updates. If you are a credentialed provider, any newly added locations will inherit your established taxonomies. Please allow up to 30 days for taxonomy, NPI and provider type changes. New taxonomies will be prioritized if recredentialing is needed.  

Effective March 1, 2024, BCBSNE will no longer make updates from these forms. Changes must be submitted and attested to in CAQH. Using this process ensures the directory reflects the most current information for our members and improves claim processing accuracy. Attesting to your information in CAQH also replaces the requirement to review your provider directory information every 90-days in NaviNet.        

Please note there are no changes to the processes below. The appropriate instructions and forms can be found in NaviNet.

  • Adding or updating EFT information
  • Adding or updating ERA information
  • Terminating all locations  
  • Adding Provisional Providers
  • Updating information for facilities/institutions

If you do not have a CAQH profile, please create one as soon as possible. For more information on creating a profile and using the CAQH Provider Data Portal please visit Proview.CAQH.org.

Delegations/PHOs handling their own credentialing should continue to follow their current processes, including sending a full roster file every 90-days. If providers covered under a delegation agreement have a CAQH profile and are attesting to their data for their location handled by the Delegation, BCBSNE will automatically receive and make updates for the 13 items listed above.

As BCBSNE communicated, starting November 1, 2023, providers are being directed to NaviNet® for self-service for all member, preauthorization/precertification, claim, reconsideration, and appeal needs.

In the event information is not available on NaviNet:

  1. Review our Happening Now to see if there is an already known issue
  2. Missing Remittance Advise (RA), reach out to your clearinghouse for the information (as applicable)
  3. Receiving an error message or information is missing on NaviNet – contact CSC to report
    • Please include the EXACT message you received on NaviNet or explain what information is missing
  4. Preauthorization request was not auto approved, and the appropriate criteria was submitted
    • Ensure your contact information (full name, phone and fax number) was included in the Notes section
    • Contact @Provider Portal Auth Questions
    • For urgent and immediate assistance, please call 800-247-1103, option 5
  5. Unable to access claim on NaviNet and need to submit Appeal or Reconsideration
    • You may fill out the recon/appeal form completing the required fields
    • Fax the correct form to the number on the bottom of the form
    • You will not be able to track the status of this form online. Please allow 45-60 days for a response.
      *Preservice appeals are not part of this process
  6. Emails or notes on forms indicating "Not available on NaviNet" with nothing to substantiate the issue will not be addressed. 

Blue Cross and Blue Shield of Nebraska (BCBSNE) requires a refund offsetting process for in-network providers. If you identify a claim overpayment has been made, please follow the claims adjustment process.

Please do not send a check/payment as the recoupment will be satisfied with a refund offset.

Please reach out to our Refunds Department at 800-562-3381 with any questions.

Note: If the offset is due to an overpayment of a Federal Employee Program (FEP) claim, offsetting will only occur on other FEP claims. We will not offset overpayments on FEP claims with claims that are non-FEP.

Read the Refund Offsetting (GP-X-095) policy.