To help providers submit accurate claims and take advantage of auto-adjudication, Blue Cross and Blue Shield of Nebraska (BCBSNE) continues to rank the top three reasons for claim returns:
The provider’s name and credentials, Federal Tax Identification (TIN) number and/or NPI are missing.
The Federal Tax Identification number 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 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.
BCBSNE is making changes to the way our EAPG edits occur. Unforeseen impacts of having NCCI edits coupled with EAPG edits with NCCI built in caused impacts to the claims pricing.
This has been corrected and system edits have been completed. NCCI edits, in addition to the EAPG edits, are now appropriately pricing claims without the need for manual intervention. Claims are processing faster, and reconsiderations no longer need to be sent for payment adjustments.
Claim Return, Reconsideration and Appeal letters are going paperless
Beginning April 1, 2024, to make it easier for our participating network health care professionals and facilities for BCBSNE plans, our claim return letters are exclusively available on NaviNet under Patient Documents. This move to paperless delivery reduces the amount of paper your office receives and allows convenient access when you need it.
On May 15, 2024, we will be adding Reconsideration and Appeal letters to this paperless process.
View the eLearning video for your reference in the Provider Academy.
If you cannot locate the letter(s), please reach out using the Claims Investigation tool explaining the steps you took in attempting to locate the letter(s) and the issue you encountered.
Quick Tips - Coding and Documentation for Controlling Blood Pressure (CBP)
Review the CBP tip sheet to help reduce medical record requests for HEDIS® compliance determination and save you time.
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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.
