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MA Provider Update October 15, 2026
Welcome to your Provider Update newsletter, your source for important updates and information about our commercial medical and dental plans. A separate Provider Update newsletter for Medicare Advantage providers will be published soon. Watch your email for notification when it becomes available.
What's inside
| General Information |
Medicare Advantage Transition Updates |
| Provider Payment | Action Required: Enroll in Electronic Payments for MA Claims by Dec. 30, 2026 MA Claims Payment Cycle |
| Preauthorization and Appeals |
Reminder: MA Priorauthorization Updates with P3 Health New Priorauthorization Transparency Requirements Coming in 2027 |
| Provider Resources and Education |
Your Future One-Stop Shop for MA Resources |
| Member and Administrative Updates |
MA Member ID Card Updates for 2027 |
General information
Medicare Advantage Transition Updates
As part of the continued transition of the Blue Cross and Blue Shield of Nebraska (BCBSNE) Medicare Advantage (MA) partnership with P3 Health Partners, several updates will take effect. These changes are designed to support a seamless experience for providers while aligning MA processes, systems, resources and communications for the next phase of the partnership.
To help providers prepare, BCBSNE will publish a series of special MA Only Transition Editions of the Provider Update newsletter in Oct., Nov. and Dec. These mid-month communications will highlight upcoming changes, important dates, required actions and educational resources leading up to the Jan. 1, 2027, implementation.
Updates in this article are organized by topic to make it easier to find information relevant to your practice. Each update is marked with a color-coded indicator to identify the level of impact:
Understanding the Change Indicators
- Red = Action Required: Providers must complete an action, registration or submission to avoid disruptions to administrative processes, claims processing or payments.
- Yellow = Process Change: Administrative or operational changes are occurring. While little or no action may be required, providers should familiarize themselves with updated processes and resources.
- Green = No Provider Workflow Changes: Updates are informational only and will have minimal impact on your existing workflows.
We encourage you to review each section carefully and complete any required actions before Jan. 1, 2027.
Provider Payment
Action Required: Enroll in Electronic Payments for MA Claims by Dec. 30, 2026
Beginning Jan. 1, 2027, MA claim payments will be issued through the Zelis ePayment Center. To continue receiving payments electronically, providers must register with the Zelis ePayment Center by Dec. 30, 2026.
What You Need to Do
- Register your organization with the Zelis ePayment Center beginning Oct. 1, 2026
- Enroll your Tax Identification Number (TIN) and designate the bank account where electronic payments should be deposited
- Complete registration by Dec. 30, 2026, to avoid payment disruption
Fee-Free Electronic Payments
Providers can enroll in Zelis' fee-free electronic payment option by registering through the Zelis ePayment Center at allymar.epayment.center.
To ensure you are enrolled in the no-cost option:
- Enroll through allymar.epayment.center
- Select standard ACH/EFT payment options
- Do not enroll in Zelis ACH+ or other premium payment programs unless you intentionally choose to do so
- Do not process Virtual Credit Card (VCC) payments, as VCC transactions may incur fees and could move you into a fee-based payment arrangement
Important Information
- Registration is completed at the TIN level
- One electronic payment account is established per TIN
- The Zelis ePayment Center is a multi-payer platform and may not display Blue Cross and Blue Shield of Nebraska branding during registration
- As part of EFT enrollment, Zelis will make a micro-deposit to validate the bank account
- Zelis uses a two-step verification and fraud review process to help protect both payers and providers
Date of Service (DOS) Transition Information
During the transition period, providers may receive MA payments from two different payment sources:
- Claims with dates of service on or before Dec. 31, 2026, will continue to be processed and paid through BCBSNE's current payment systems
- Claims with dates of service on or after Jan. 1, 2027, will be processed and paid through the Zelis payment platform
As a result, providers may temporarily receive payments from both systems while 2026 claims continue to be processed.
If You Do Not Register
Providers who have not enrolled in EFT through the Zelis ePayment Center by Dec. 30, 2026, will receive:
- Paper claim payments (checks)
- Paper Explanations of Payments (EOPs)
Electronic funds transfer (EFT) and electronic remittance advice (ERA) will not be available until enrollment is completed.
This information was previously communicated in our Oct. 1, 2026, NaviNet article. For questions, providers may contact Zelis Customer Service at 877-828-8770.
MA Claims Payment Cycle
The MA transition will not impact provider payment timing. MA claims will follow BCBSNE's current 21-day payment cycle, consistent with the commercial line of business. No provider action is required. For additional details, please review the Provider Claims FAQ.
Claims (Availity)
Action Needed: MA Claim Submission Requirements for 2027
Beginning Jan. 1, 2027, MA claims administered through P3 Health Partners must be submitted using payer ID A6492. Claims with dates of service before Jan. 1, 2027, should continue to be submitted using payer ID 77780.
For claims spanning multiple calendar years, charges must be submitted on separate claims based on the year services were incurred.
For example, if dates of service span Dec. 15, 2026, through Jan. 15, 2027:
- Submit Dec. 15, 2026, through Dec. 31, 2026, charges on one claim using payer ID 77780
- Submit Jan. 1, 2027, through Jan. 15, 2027, charges on a separate claim using payer ID A6492
Claims containing charges from multiple calendar years on the same claim will be rejected for correction and resubmission. Using an incorrect payer ID may also result in processing delays.
This information was previously communicated in our Aug. 3, 2026, Happening Now article
MA Reimbursement Changes Effective Jan. 1, 2027
BCBSNE recently mailed letters to affected providers and posted information in NaviNet® regarding MA reimbursement changes effective Jan. 1, 2027.
The changes apply to non-PHO laboratory, radiology and skilled nursing facility providers. The updated methodology establishes a more consistent CMS-based reimbursement framework and, for skilled nursing facilities, creates a clearer connection between quality performance and reimbursement.
This information was previously communicated in our Oct. 1, 2026, NaviNet article. Providers should review NaviNet for the updated rates and additional information.
Action Needed: MA Interim Rate Letters
To ensure accurate reimbursement for MA claims, in-network Critical Access Hospitals (CAHs) and Rural Health Clinics (RHCs) must continue to submit updated interim rate letters issued by CMS.
How do I submit my MA rate letter?
Submit the CMS MA interim rate letter through the Provider Advanced Inquiry tool in NaviNet and include the following information:
- Provider TIN
- Provider Medicare ID (NPI)
- Method I or Method II designation
When do I need to submit my rate letter?
Rate letters must be submitted within 60 days of publication by the Medicare Administrative Contractor (MAC).
Why is this important?
Interim rate letters are used to establish the reimbursement rates applied to eligible MA claims. If an updated rate letter is not submitted, claims may be processed using the most recent rate information on file. Reimbursement will not be retrospectively adjusted when a later rate letter is received.
Looking Ahead
Additional information regarding MA provider inquiries and submission processes will be communicated as we prepare for the transition to the P3 Availity Provider Portal on Jan. 1, 2027.
Coming Jan. 1, 2027: MA Providers Will Transition to Availity
Exciting changes are ahead for MA providers.
As part of BCBSNE’ s expanding partnership with P3 Health Partners, MA providers will transition from NaviNet to the P3 Availity Provider Portal beginning Jan. 1, 2027. At that time, P3 Health Partners will also assume responsibility for processing MA claims with 2027 dates of service.
The new portal will serve as a central resource for MA business, helping streamline provider interactions and support future enhancements. Providers can expect updates regarding portal access, training opportunities, available functionality and key transition milestones in the months leading up to implementation.
No action is needed at this time. We wanted to share this exciting news early so you can begin planning for the transition. Additional details will be communicated through upcoming MA newsletters and provider communications as we get closer to the Jan. 1, 2027, go-live date.
This information was previously communicated in our Oct. 1, 2026, Happening Now article. Stay tuned for more information as we continue working to enhance the MA provider experience.
Process Change: MA Claim Submission Options
The preferred method for submitting MA claims continues to be through Electronic Data Interchange (EDI). Providers may submit claims through their preferred clearinghouse if they are credentialed with BCBSNE.
Beginning Jan. 1, 2027, the PC-ACE billing software will no longer be available for MA claims with dates of service on or after Jan. 1, 2027. Providers who do not use a clearinghouse will have the option to submit MA claims directly through the P3 Availity Provider Portal.
Providers should also be aware that paper MA claims mailed to BCBSNE for dates of service on or after Jan. 1, 2027, will be returned and will not be processed.
Claim Status Inquiries
Beginning Jan. 1, 2027, claim status inquiries for MA claims with 2027 dates of service will be available through the P3 Availity Provider Portal. Claim Appeals
MA claim appeals will be submitted via fax. Additional guidance, including submission requirements and resources, will be provided as the transition date approaches. Printed Remittance Documents
Providers will begin receiving printed Explanation of Payment (EOP) documents by mail for applicable MA claims. More information about payment and remittance processes will be shared before implementation. Process Change: Electronic Remittance Advice (835s)
Because MA claims with 2027 dates of service will be submitted to a separate payer ID, providers will receive separate 835 remittance files for MA and Commercial business. This change will help align remittance information with the appropriate payer and claim submission process. Process Change: Claim Correspondence
Claim-related correspondence, including return letters, reconsideration outcomes and appeal determinations, will be delivered by mail or fax. Additional details will be provided as implementation approaches. Coming Soon: Provider Inquiries
Today, many providers use the Provider Advanced Inquiry tool for claim and administrative questions. As part of the transition to the P3 Availity Provider Portal, a new inquiry process will be introduced for MA business. Additional information, provider education and eLearning opportunities will be shared in the coming months to help providers prepare for this change.
Preauthorization and Appeals
Reminder: MA Priorauthorization Updates with P3 Health
As a reminder, effective May 1, 2026, all MA medical and medical pharmacy priorauthorization requests transitioned to P3 Health Partners and are submitted through the P3 Provider Portal, accessed via NaviNet single sign-on (SSO). Providers can use the portal to submit authorization requests, search existing authorizations and upload medical records.
Authorization decisions continue to be communicated via fax, and authorization status for requests submitted on or after May 1, 2026, can be viewed within the P3 Provider Portal.
In addition, effective Oct. 1, 2026, P3 Health Partners assumed responsibility for managing MA priorauthorization appeals and grievances on behalf of BCBSNE. No significant workflow changes were required for providers as part of this transition.
Need assistance with submitting priorauthorization requests through the P3 Provider Portal? Training resources are available through the MA/P3 eLearning library. The eLearning modules provide step-by-step guidance on submitting authorization requests, searching authorizations and uploading medical records.
Beginning Jan. 1, 2027, the P3 Provider Portal will transition to the P3 Availity Provider Portal as part of the next phase of the BCBSNE and P3 Health Partners partnership. Additional information, training and resources will be provided as the transition date approaches.
New Priorauthorization Transparency Requirements Coming in 2027
Effective Jan. 1, 2027, BCBSNE will implement federal interoperability and priorauthorization transparency requirements under the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F). BCBSNE will publish annual priorauthorization metrics, maintain information regarding services requiring priorauthorization and make available educational resources related to health information exchange initiatives. For more information, visit the CMS Interoperability and Prior Authorization Final Rule webpage.
At this time, no action is required from providers. Additional details will be shared in upcoming provider communications prior to the Jan. 1, 2027 effective date. This information was previously communicated in our Sept. 30, 2026, Happening Now article.
Provider Resources and Education
Your Future One-Stop Shop for MA Resources
As part of the transition to the P3 Availity Provider Portal, we're enhancing the MA Provider Resources & Education experience to make it easier to find the information you need in one convenient location. The redesigned resource center will serve as a central hub for MA provider information and education.
Planned enhancements include:
- A dedicated P3 transition timeline highlighting completed and upcoming MA changes.
- Easy access to MA forms, policies and procedures, FAQs, eLearnings and contact information.
- A centralized location for Happening Now updates and other MA provider communications.
- Streamlined navigation designed to help providers quickly locate the resources they need.
Beginning Jan. 1, 2027, providers will access MA business through the P3 Availity Provider Portal, making it the preferred destination for MA resources and operational information. Additional details, including the launch date of the enhanced resource experience, will be communicated as the Jan. 1, 2027, transition approaches.
Stay tuned for more information as we continue to build a more connected and streamlined MA provider experience.
Member and Administrative Updates
MA Member ID Card Updates for 2027
Effective Jan. 1, 2027, BCBSNE MA member ID cards will have a new look.
What Providers Need to Know
- All MA members will receive a new member ID card for 2027.
- Existing MA members who had coverage in 2026 will keep the same member ID number for 2027.
- QR codes will no longer appear on MA member ID cards.
- The applicable payer ID, A6492, for MA claims with dates of service Jan. 1, 2027, and after will be displayed on the member ID card to help providers identify the correct payer ID when submitting claims.
- The member ID card will also include the claims submission address for 2027 MA claims.
PO Box 5015
Scranton, PA 18505
Example of New Member ID Card
Provider Action
Please review member ID cards presented at the time of service and use the member ID number and payer ID shown on the card when submitting claims, checking eligibility or benefits, requesting priorauthorization and conducting other member-specific transactions.
This update is especially important as MA claims with 2027 dates of service will be submitted using a separate payer ID from Commercial and Dental claims. The payer ID displayed on the member ID card can help ensure claims are submitted correctly and help avoid processing delays.
Sign up for NaviNet®
Registration is free and requires only a Federal Tax ID. Participating BCBSNE healthcare and dental providers are eligible to enroll for access.
If your office already uses NaviNet, contact your Security Officer to set up your account. If your office does not use NaviNet, visit Register for NaviNet to begin the registration process.
Stay informed with BCBSNE provider communications
Log in to NaviNet Plan Central and sign up for BCBSNE provider emails to receive notifications when new Provider Update newsletters are available. Provider Update newsletters are an extension of your provider contract and may include important operational, policy and administrative information. Be sure your contract and contact information are current so you receive timely updates and communications from BCBSNE.