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.
Top three claim return reasons
To help ensure your claims are processed in a timely manner, and to take advantage of auto-adjudication, BCBSNE continues to rank the top three reasons for claim returns:
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.
The provider’s name and credentials, Federal Tax Identification number and/or NPI are missing.
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 into NaviNet or call our automated voice system at 800-635-0579.
New claim-denial information available in NaviNet
We are excited to announce improved denial messages in NaviNet. These enhanced messages will provide you with the information needed to determine next steps on the claim denial, and will help avoid the need to contact Customer Service.
After performing a Claim Status Search, specific denial messages will be shown for each denied claim line in the Claim Status Details section. Denial messages corresponding to the claim line number will be displayed directly above the Claim and Service Line Details.
Reconsideration vs Timely Filing
Please ensure you are using the reconsideration form rather than a timely filing override request for requests pertaining to coordination of benefits (COB), workers’ compensation, and subrogation adjustments.
Effective Jan. 1, 2024, BCBSNE are no longer working or returning incorrectly filed timely filing requests. If your request was filed incorrectly, please submit using the correct form.
Example scenario: 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.
Provider sanction for non-Nebraska claims
If a provider obtained a prior authorization or retro authorization from a 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
BCBSNE will notify you of the decision made by member’s plan as they determine if the claim will be reprocessed or if the denial is upheld.
BCBSNE response to new RSV codes
New RSV Codes:
90678 and 90679 effective Jun. 21, 2023
90380 and 90381 effective Jul. 17, 2023
96380 and 96381 effective Oct. 6, 2023
BCBSNE response to the RSV codes listed above.
Providers should ensure they are using the correct NDC number in addition to the correct dx code
Prior authorization may be required - it is important to validate benefits and preauthorization requirements prior to service being rendered
If our member elects to have this done in a pharmacy, prior authorization may be required outside FDA-approved and CDC supported use
BCBSNE allows for all children under the age of 2 to receive the RSV immunization regardless of diagnosis. Age 2 and older will deny as investigational
BCBSNE allows for any age with gestation diagnosis codes for 32 through 36 weeks of gestation of pregnancy
BCBSNE allows for age 60 and above with a preventive diagnosis. Medical diagnosis will apply member's cost share
All other RSV vaccines will pay following the CDC recommendations
Provider Directory updates in CAQH starting Jan. 16, 2024
Effective Jan. 16, 2024, BCBSNE will automatically receive directory updates from CAQH for the items listed below. By submitting your directory updates in CAQH, you can avoid the need of submitting a BCBSNE Provider Add/Extend/Transfer, Change of Address, and/or NPI form.
Name (first, middle initial, and last)
Suffix
Office telephone number and extension
Location fax number
Primary email address
Location additions, changes and terminations
Gender
Date of birth
Languages spoken
Accepting new patients
NPI
Provider type
Primary practice indicator
Taxonomy
Demographic changes will be updated in the provider directory within 48 hours from submission. Please allow up to 30 days for taxonomy, NPI, provider type and location updates. New taxonomies will be prioritized if recredentialing is needed.
Effective March 1, 2024, BCBSNE will no longer make directory updates based on information provided on the forms. Changes must be submitted and attested-to in CAQH. Attesting to your information in CAQH replaces the requirement to review your provider directory information every 90 days in NaviNet.
Please note there are no changes to the processes below, and 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, RBTs, and BCaBAs
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 14 items listed above.
Do you have a new team member who would like to be added to our email list?
They can sign up to receive an email when a new edition of Provider Update and Provider Bulletin have been added to our Alerts and Updates page.
