All Blue Cross and Blue Shield of Nebraska (BCBSNE) Medicare Advantage (MA) members received new ID numbers on Jan. 1, 2025. Please ensure you are using their new ID number for services received on or after Jan. 1, 2025.
2025 MA prescription benefits
We are delighted to offer our MA members the ability to fill prescriptions for 100 days in 2025.
Filling maintenance medications for 100 days at a time is not only convenient but also helps patients stay adherent to their treatment plans and take their medications as prescribed by their health care provider.
Retired: MA Medical Pharmacy prior authorization form
We recently communicated a change in the management of certain drugs under the medical benefit for MA members. The prior authorization requests can be submitted via web exclusively through GatewayPa.com. The MA Part B drug request form has been retired and you will no longer be able to submit these prior authorizations via fax.
Thank you for your continued support in ensuring our members receive high-quality and clinically appropriate care.
MA Dental reminders
MA dental plans are reimbursement policies only. Members pay the full amount to the provider and then they will submit a claim for reimbursement.
To assist your patients, please consider providing them with documentation that includes your TIN and NPI numbers. This will make filing and reimbursement easier for them.
Reimbursement amounts vary by plan:
Core HMO is $1,950
Connect PPO is $1,500
Access PPO is $2,050
Secure PPO is $2,050
All plans have no deductible, and covered services must be performed by a licensed dental provider. Please contact the member to confirm which dental plan they have.
General Information
Updating NPPES data registry
Our Medicare pricing tool uses the NPPES data registry to link the Medicare Number/CCN with the NPI data listed in the registry. If there is a discrepancy between the data in the registry and what is submitted on the claim, the claim may be delayed or potentially returned. Therefore, it is crucial for providers to ensure accurate updates to the NPPES and to deactivate outdated information.
Contact change for joining the University NE System Network
In 2024, the University of Nebraska joined BCBSNE. Members of this plan have access to a three-tier network for their medical coverage. Providers within the University NE System Network are classified as Tier 1 and offer the lowest out-of-pocket costs for members. Network BLUE providers fall under Tier 2. Tier 3 encompasses all other providers.
For those interested in joining the University NE System Network, please contact Brian Schlichting by phone at 402-472-5258 or email at bschlichting@nebraska.edu.
HEDIS® Medical Record Reviews
From February through May each year, BCBSNE conducts medical record reviews to gather essential Healthcare Effectiveness Data and Information Set (HEDIS) measurement quality data for our members. This process is crucial for assessing the quality of care provided to our patients.
Data Collection Process:
Commercial Members: Data is collected using Reveleer®.
Medicare Advantage Members: Data is collected through Datavant Health.
Both Reveleer and Datavant Health will reach out to your clinic to request specific clinical details that may not be included in claims data, such as: Blood pressure readings, HbA1c lab results and Colorectal cancer screenings.
Your cooperation in providing these records is vital. It not only helps us meet our quality goals but also enhances the overall health of our members — your patients.
Contractual Obligations:
As a participating provider, your contract includes provisions for supplying requested records to BCBSNE or our third-party vendors at no charge. We aim to minimize disruptions to your office workflow; therefore, prompt responses to these requests will reduce the need for follow-ups.
Thank you for your assistance in this important initiative. Your support is invaluable in helping us successfully complete our HEDIS reporting.
For more information on HEDIS, please visit NCQA.org.
Reminders
BCBSNE ends timely filing exception on Oct. 24, 2024
As we posted to Happening Now on Dec. 19, 2024, as a result of the Change Healthcare cyberattack that occurred nearly a year ago and suspended claims processing services for many providers, BCBSNE extended financial assistance, facilitated transitions to new clearinghouses and allowed timely filing extensions when appropriate. Please note that as of Oct. 24, 2024, we have returned to adhering to contractual timely filing limits for all providers.
Timely Filing Requests transition to NaviNet®
Effective Jan. 1, 2025, BCBSNE no longer accepts paper (faxed or mailed) timely filing override requests. As part of our ongoing transition to paperless processes, all timely filing override requests must be submitted via NaviNet.
Please note that we will no longer process or return paper timely filing override requests received via fax or mail.
BCBA licensure requirement
As we advised on Happening Now on Oct. 4, 2024, the Nebraska Applied Behavior Analyst Board has announced that all Behavior Analysts practicing in Nebraska must obtain state licensure within 90 days following Sept. 2, 2024. BCBSNE will update licensure requirements for this provider type during recredentialing.
Please be sure to update your professional license information in the personal information section in the CAQH Provider Data Portal.
For those applying for initial credentialing, please have your license number before applying. BCBSNE is returning applications if licenses are not included on the application. If you have already submitted your application, please reapply when you receive your license. Previous board certification will still be required.
Behavior Analysts who are due for recredentialing and do not have a license on file will have their participation terminated until a new application with license is submitted. Previous board certification will be needed.
Urgent Radiology Preauthorization Request line retired
Effective Jan. 2, 2025, BCBSNE retired the Urgent Radiology Preauthorization Request phone number: 402-982-8870 or 800-247-1103.
Please update your records accordingly and direct all future radiology-related inquires via NaviNet.
We appreciate your cooperation and understanding.
Split-year claim billing
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.
How to submit a claim
The preferred way to submit claims is through the Electronic Data Interchange (EDI). Claims can be submitted through your preferred clearinghouse as long as you are a BCBSNE-credentialed provider. If you do not already have a clearinghouse, BCBSNE offers free billing software and support to help you submit claims electronically. Learn more about the Electronic Data Interchange and PC-ACE Software.
If circumstances necessitate submitting claims on paper temporarily, please inform your Provider Executive. Their information can be found on NebraskaBlue.com.
This notification will enable us to prepare for the receipt of paper claims and help mitigate any potential downstream delays.
Emailing Provider Executives
Emails are handled in the order received; however, emails are not processed unless the below information is included.
Provider name, NPI and TIN
Claim numbers (if applicable)
Member name and ID
DOS
Expected outcome or reimbursement
Additionally, the appropriate steps MUST be followed BEFORE submitting an escalation request to this email box:
Step One: NaviNet
Please access NaviNet for all member, claim, authorization and appeal needs. If you do not have access to NaviNet please register by following the steps at Provider Academy.
Step Two: Contact
If NaviNet is unsuccessful, please use the claims investigation tool located in NaviNet.
Step Three: Escalating
For claim escalation needs that you are unable to resolve through NaviNet or Customer Service Claims (CSC) Investigation, you can email this email box and include why NaviNet or Claims Investigation was not successful. You should also include the inquiry number from Customer Service.
For fee schedules:
All fee schedules are available in NaviNet and will no longer be available via CSC, email or inquiry.
If you are affiliated with a PHO, you must obtain the fee schedule from the PHO.
For timely filing:
Please submit your request via NaviNet using the Timely Filing form.
Please remember: Coordination of Benefits (COB) is not a member ID exception. Please complete the reconsideration form on NaviNet if another insurance was billed, recouped or denied the claim and you then submitted to BCBSNE.
Provider Executives no longer address COBs submitted incorrectly on a timely filing form.
Do you have a new team member who would like to be added to our email list?
They can sign up for Provider updates online in the same location as our Provider Updates newsletter on the Alerts and Updates page.
You are receiving this because you are identified as a provider for Blue Cross and Blue Shield of Nebraska.
NaviNet® is a healthcare provider portal providing services for Blue Cross and Blue Shield of Nebraska, an independent licensee of the Blue Cross Blue Shield Association.
