As we shared on Happening Now and NaviNet® on March 6, 2026, and as a follow-up to the payment cycle adjustments announced last August and implemented Nov. 1, 2025, we want to provide additional clarity on the weekly payment cycle:
There is no single “catch-up” payment under the new cadence.
Weekly payment amounts will not return to pre–Nov. 1 patterns even as the alignment is complete.
Payment amounts will vary from week to week depending on when submitted claims reach the 21-day threshold.
Month-end billing patterns may create one higher payment approximately three weeks later, followed by a lower payment the next week; this is expected.
These patterns reflect the normal operation of a true rolling 21-day payment cycle.
Why you may be seeing variability
Your weekly reimbursement totals may appear lower or inconsistent compared to pre–November 2025 cycles. The payment cycle is operating as intended, and the variability you see is likely due to one or more of the following:
Change in business mix
Fluctuating claim submission volumes
Timing of when claims reach the 21-day mark
Typical month-end submission patterns
Clearinghouse batching (weekly, biweekly or monthly), which can delay the received date and shift when claims fall into a payment cycle
Because settlement transitioned from Thursdays to Mondays, claims processed late in the month may settle in a different month
Our commitment to you
We understand that changes to payment timing impact cash-flow planning, and we are committed to answering your questions and providing transparent communication as you adjust to this change.
We value your partnership and your feedback.
If you have questions about specific payment weeks or need support understanding the timing of claim batches, our teams are here to assist you.
We announced earlier this month on Happening Now an enhancement to the CoverMyMeds (CMM) preauthorization process to make it easier for providers to access decision information.
Beginning Feb. 26, 2026, pharmacy preauthorization decision letters for requests decisioned on or after this date will be available directly within CMM. This enhancement gives providers faster access to decision details in the same platform they already use to submit and track requests.
What to expect
Letters for requests decisioned before Feb. 26, 2026 will not appear in CMM.
Blue Cross and Blue Shield of Nebraska (BCBSNE) will continue faxing all preauthorization decision letters to the ordering physician’s fax number on record.
The BCBSNE preauthorization reference number will continue to appear on the faxed decision letter and can also be obtained through our automated IVR phone system.
Please use these resources before contacting Customer Service.
Peer-to-peer reminder
BCBSNE continues to follow the standard 72-hour turnaround time for peer-to-peer requests.
Medical record review period: January – May 2025
Each year, BCBSNE conducts medical record reviews from February through May to collect essential data for HEDIS® (Healthcare Effectiveness Data and Information Set) reporting. These reviews help us assess the quality of care provided to our members and identify opportunities for improvement.
What to expect
BCBSNE partners with Reveleer, our medical record retrieval vendor, to coordinate outreach to provider offices during the annual HEDIS review period. Your clinic may receive requests for specific clinical information not available through claims data.
These requests may include:
Blood pressure readings
HbA1c lab results
Colorectal cancer screening documentation
Transitions of care records, including:
Post-discharge medication reconciliation
Admission and discharge summaries to confirm provider notification
Your timely response is essential to support accurate quality reporting and improve patient outcomes.
Provider responsibilities
As a participating provider, your contract includes provisions requiring you to supply requested medical records to BCBSNE or its designated third-party vendors at no cost. We strive to minimize disruption to your workflow and appreciate prompt responses to avoid repeated follow-ups.
Why it matters
Your support in this initiative helps us:
Meet HEDIS quality measurement goals
Ensure accurate reporting
Improve the health and well-being of our members and your patients
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 Advocate. 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.
BCBSNE Eliminates PA for Non‑Contrast CT Scans
As part of our ongoing effort to simplify processes and reduce administrative burden for providers, BCBSNE is excited to announce a significant update: Beginning March 3, 2026, prior authorization requirements for non‑contrast CT scans will be eliminated across both Medicare Advantage and Commercial lines of business.
This change supports a more seamless experience for members and providers and reflects our continued commitment to thoughtfully reimagining preauthorization.
The following codes no longer required prior authorization beginning March 3, 2026:
BCBSNE conducts settlements on hospital claims for BCBSNE MA members. This applies to in-network Critical Access Hospitals and Rural Health Clinic providers. Below are a few FAQ reminders on the MA interim reimbursement letters.
How do I submit my MA rate letter provided by CMS?
Please submit the CMS MA rate letter via the Advanced Provider Inquiry tool on NaviNet
Please include the information in the format below:
Provider TIN
Provider Medicare ID# (Provider NPI)
Provider Method I or II
When do I need to submit these requests?
Rate letters must be submitted within 60 days of being published by the MAC.
MA updates CPT II claims handling to improve STARS reporting
To support more accurate STARS quality reporting, we’ve updated how Medicare Advantage (MA) claims containing CPT II codes are processed. CPT II codes are informational quality measure codes (such as blood pressure readings or A1c results) and are important for capturing data used in STARS ratings.
What’s Changing
Outpatient institutional claims will no longer be returned when a CPT II code triggers an edit.
Instead:
The CPT II code will deny at the line level, and
The rest of the claim will continue to process normally.
This approach allows us to capture quality information without delaying or disrupting payment for covered services.
Critical Access Hospital (CAH) Claims
We are reprocessing previously returned CAH claims affected by this edit to ensure the CPT II information is recorded.
If a claim was already resubmitted and paid, any additional submissions will deny as duplicates to prevent duplicate payments.
What Providers Need to Do
This update does not require any changes to your current billing practices. This message is for informational purposes only.
We appreciate your continued partnership and your ongoing submission of CPT II codes. Sharing this information is essential for accurate STARS measurement and supports improved care outcomes for our members.
Before presenting an Advanced Beneficiary Notice (ABN) to a member, providers must verify benefits with BCBSNE or the member’s plan. ABNs should not be used for services that are covered because this can lead to unnecessary costs and member abrasion. Covered services vary by plan, so confirming benefits is essential before presenting an ABN.
When an ABN is required
An ABN or waiver must be signed before services are rendered if the service may be denied as not medically necessary, investigative or not scientifically validated. Providers must also inform the member in writing of potential financial liability and estimated costs.
For Federal Employee Program (FEP) members, a signed ABN is mandatory. Documentation in medical records will not be accepted.
Balance billing is prohibited
In-network providers cannot balance bill BCBSNE members for amounts beyond the BCBSNE allowance for covered services.
Preauthorization appeal process reminders for providers
BCBSNE is committed to supporting providers and promoting a smooth, efficient experience when submitting preauthorization appeals. To help reduce delays and ensure timely review, we encourage all providers to review the steps below and use the correct submission channels.
Submitting a preauthorization appeal
When a preauthorization request is denied, providers may submit an appeal for reconsideration. To begin this process, providers must complete the Appeal Request Form, available on the Provider Forms page.
Please note that preauthorization appeals cannot be submitted through NaviNet. These appeals must be sent to BCBSNE manually using one of the methods listed below.
How to submit
Mail
Appeals Department
Blue Cross and Blue Shield of Nebraska
PO Box 3248
Omaha, NE 68180-0001
Why this matters
Submitting preauthorization appeals using the correct process helps ensure documentation is clear and complete, which supports timely and accurate review. Providers who follow the manual submission process help reduce administrative delays and improve the overall experience for their patients.
Reminder: Partnering for better outcomes: Preparing for GLP‑1 preauthorization
As shared in our November 2025 Happening Now update, BCBSNE values our partnership with providers in delivering safe, effective care. GLP‑1 medications can play an important role in treatment plans, but successful prior authorization starts with following evidence-based guidelines and medical policy requirements. Taking the right steps up front helps members access care faster and reduces administrative delays.
Steps for a successful GLP‑1 request
Verify coverage and PDL status
Before submitting an authorization request, confirm that GLP‑1 medications are covered under the member’s plan and listed on the Preferred Drug List (PDL).
Not all BCBSNE plans cover GLP‑1s for weight loss or include these medications on the formulary.
If these medications are covered for weight loss, the member must complete at least three months of dietary changes and behavioral modifications before a GLP‑1 request can be considered. These steps are essential for long‑term success and are required by policy.
Review the medical policy
Confirm the requested medication meets BCBSNE criteria. Complete details are available in Medical Policy 532. Reviewing the policy ensures compliance with FDA‑approved indications and avoids unnecessary denials.
Document lifestyle interventions
Include evidence of at least three months of dietary changes and behavioral modifications. These steps are required by policy and support sustainable health outcomes.
Verify FDA‑approved use
Ensure the medication is prescribed for an approved FDA indication. This supports safe prescribing practices and helps prevent delays.
Gather complete clinical documentation
Include medical history, diagnostic results and evidence of lifestyle changes. Complete documentation speeds review and reduces back‑and‑forth.
Why these steps matter
Following these steps ensures members receive care that is clinically appropriate and effective. It minimizes administrative delays, improves member satisfaction and supports better health outcomes. BCBSNE medical policies are designed to align with current clinical guidelines and evidence‑based standards.
Quick‑reference checklist for providers
Verify coverage and PDL status
Review Medical Policy 532
Confirm three months of documented lifestyle changes
Verify FDA‑approved indication
Submit complete clinical documentation
Colon cancer screenings save lives—and are covered for preventive care
Colorectal cancer is the second-leading cause of cancer death in the United States yet remains one of the most preventable. Early detection through routine screenings can significantly improve outcomes. BCBSNE is committed to partnering with you to ensure patients have access to these lifesaving services.
Screening guidelines
The U.S. Preventive Services Task Force recommends routine colorectal cancer screening for adults ages 45 to 75. For adults ages 76 to 85, screening decisions should be based on individual health status, prior screening history and patient preferences.
Approved screening methods include:
Colonoscopy (every 10 years)
Fecal immunochemical test (FIT) or high-sensitivity guaiac fecal occult blood test (annually)
Stool DNA-FIT test (every 1 to 3 years)
CT colonography (every 5 years)
Flexible sigmoidoscopy (every 5 or 10 years, sometimes combined with annual FIT)
Discuss these options with patients to determine the most appropriate method based on risk factors and preferences.
BCBSNE coverage details
BCBSNE covers colorectal cancer screenings as preventive services under the Affordable Care Act. Eligible members pay no out-of-pocket costs when services are billed correctly and performed by in-network providers.
Coverage includes:
Initial screening colonoscopies, including bowel prep, sedation, lab work and facility fees
Follow-up colonoscopies after abnormal results when billed with the appropriate modifier (e.g., Modifier 33)
Stool-based tests and other approved screening methods used for preventive purposes
Accurate coding and documentation are essential to ensure patients receive full coverage and providers receive timely reimbursement.
Why it matters—and how you can help
Nebraska ranks below the national average for colorectal cancer screening rates. Increasing awareness and access to preventive services is critical. Because colon cancer often presents no symptoms in its early stages, routine screening is essential for early detection and treatment.
Your role is vital. Proactively engage patients in conversations about screening—especially those who may have delayed care during the pandemic. Together we can close gaps, improve outcomes and save lives.
Ensuring accuracy: BCBSNE's upcoming Risk Adjustment Data Validation audit
Ensuring accuracy: BCBSNE's upcoming Risk Adjustment Data Validation audit
CMS conducts an annual Risk Adjustment Data Validation (RADV) audit. The RADV audit verifies diagnosis codes submitted for payment and the corresponding medical records. BCBSNE will begin the process to retrieve medical records in March and April.
Under the terms of your contract with BCBSNE, health care professionals and facilities agree to submit requested medical records in a timely manner at no cost to the patient or to BCBSNE. Patients have already consented to release medical records to us. An additional release is not required for this audit.
All information resulting from the review is confidential.
Vendor Risk is Nebraska’s Emerging Cyber Challenge
Over the past few years, most major healthcare breaches—including those impacting Nebraskans—originated not from hospitals or clinics themselves, but from third‑party vendors and service providers. Nationwide patterns show that over 80% of compromised health records come from outside direct patient‑care systems (American Hospital Association).
For Nebraska clinics, this means Vendor Risk Management (VRM) must become part of daily operations. Ask partners about their cybersecurity controls, require multi‑factor authentication and review who they share your patients’ information with. By treating vendor security as seriously as internal security, Nebraska health care organizations can better protect themselves and the patients who count on them every day.
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. HEDIS, which stands for Healthcare Effectiveness Data and Information Set, is a registered trademark of the National Committee for Quality Assurance (NCQA). Reveleer® is a healthcare SAAS platform that retrieves medical records for Blue Cross and Blue Shield of Nebraska, an independent licensee of the Blue Cross Blue Shield Association.
