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 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’s Medicare Advantage plan is moving in house for 2025
We’re excited to announce that in 2025, we will bring the operations of our Medicare Advantage (MA) program fully in house, which will provide key benefits for you, our health care provider partners.
What’s changing
Currently, BCBSNE works with a third-party vendor to manage our MA program. Effective Jan. 1, 2025, we will bring the operations our MA program fully in house.
Benefits of this change
This change will enable us to better support you, our health care provider partners, in serving your patients who have a BCBSNE MA plan. Key benefits will include:
Utilization Management: Providers will be able to submit MA preauthorizations via NaviNet®. These preauthorizations can be tracked in the same way as our commercial members' preauthorizations. We will also be expanding the MA authorization types that we allow for submission on the portal. Discharge planning will be managed by BCBSNE.
Claims processing: Once the transition is complete, BCBSNE will begin processing MA claims directly. You can expect the claims process for MA to mirror BCBSNE’s familiar commercial claims process.
By processing claims directly, BCBSNE will be able to provide you with an enhanced experience, as our Provider Executive team will have a line of sight on claims and be able to support you should you have questions.
Enhanced customer service experience: BCBSNE will have a local, Nebraska-based customer service team available to answer MA questions once the transition is complete.
Please note: The customer service phone number for MA will not change. Please continue to call 888-505-2022 for BCBSNE MA member eligibility, benefits and claims questions.
Access to Medicare Advantage on NaviNet: After the transition is completed on Jan. 1, 2025, providers will have access to claims, eligibility, benefits, preauthorization and other items available on NaviNet for the Medicare Advantage line of business.
We will share more information about this change soon. If you have any questions in the meantime, please reach out to your Provider Executive.
Reminder: Taxonomy code requirement
Did you know? When submitting a claim, the correct provider taxonomy must be on the claim for it to process. This is the taxonomy you were credentialed with and could be different from NPPES. Please see Claims FAQs on our Provider Academy.
What is provider taxonomy? Provider taxonomy is a set of 10 alphanumeric characters that define specific specialty categories for providers (individual, group or institution). There are different levels defined in the code set, including Provider Grouping, Classification and Area of Specialization. Providers may identify under more than one code set.
How does this affect you? Please ensure you are submitting the correct taxonomy. This information is needed for credentialing, delegated updates, and claims processing. It is important that the taxonomy matches the credentialed taxonomy on file with BCBSNE. When the appropriate information is not submitted, the claim will be returned.
For newly credentialed providers, please reference your letter with effective date and taxonomy code listed. An excellent source for more information on taxonomy is NUCC.org.
EAPG Providers
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.
Review your demographic data in CAQH every 90 days.
The last provider directory file available in NaviNet will be Aug. 5, 2024. To ensure your information remains accurate and up to date, BCBSNE in-network providers are required to verify demographic data every 90 days and attest to your information through your CAQH portal.
For further information on utilizing CAQH please review our Provider Academy.
Department of Corrections Claims
The Department of Corrections has made a change to their member benefits that impacts the way claims are processed. Beginning Jan. 1, 2024, members whose ID numbers begin with 888 and are IP longer than 24 hours, could qualify for Medicaid.
If the member does qualify for Medicaid, the Department of Corrections will inform the provider of the Medicaid coverage. Claims submitted to BCBSNE for these members will deny as provider liability.
These claims will not be eligible for appeal or reconsideration. There is no need to contact Member Services or your Provider Executive. Please direct questions about these denials to the Department of Corrections or Medicaid for eligibility information if needed.
G0109 (Group Diabetic Education) will be added to our telehealth policy effective July 1, 2024
G0109 follows the same guidelines as other telehealth codes and requires modifier 95 with a place of service 02 or 10. In addition, the service must be billed by an approved telehealth provider.
Quick Tips for Coding and Documentation – Diabetes Care Measures
BCBSNE is here to help your medical billing and medical record documentation processes go smoothly. This can help reduce medical record requests for HEDIS® compliance determination and save time.
Read on to learn more about specific diabetic measures, including best practices.
Glycemic Status Assessment (GSD)
Information patient medical records should include:
Document the date and result of all glycemic status assessments (HbA1c or GMI). The last glycemic status assessment of the measurement year must be less than or equal to nine to show evidence of diabetes control.
Information patient claims should include:
When conducting an HbA1c in your office, submit the distinct numeric results as $0.01 on the HbA1c claim with the appropriate CPT® II code:
CPT II code
Most recent HbA1c level
3044F
< 7%
3046F
> 9%
3051F
≥ 7% and < 8%
3052F
≥ 8% and ≤ 9%
Eye Exam for Patients with Diabetes (EED)
Information patient medical records should include:
When you receive an eye exam report from an eye care provider for your patient with diabetes:
→ Document the date of the eye exam, the retinopathy results and eye care professional’s name and credentials in the medical record
→ Review the report and note if there are any abnormalities. If so, add the abnormalities to the patient’s active problem list and indicate the necessary follow-up
→ Place the report in the patient’s medical record
For patient-reported retinal or dilated eye exams, document in the patient’s medical record the date of the eye exam, the retinopathy result and the eye care professional who conducted the exam with credentials. If the name of the eye care professional is unknown, document that an optometrist or ophthalmologist conducted the exam.
Information patient claims should include:
When results are received from an eye care professional or the patient reports an eye exam, submit the results on a $0.01 claim with the appropriate CPT II code:
CPT II code
Retinal eye exam findings
2022F
Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed; with evidence of retinopathy
2023F
Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed; without evidence of retinopathy
CPT code
Automated eye exam with AI interpretation
92229
Imaging of retina for detection or monitoring of disease; point-of-care automated analysis and report, unilateral or bilateral (interpreted by artificial intelligence)
Kidney Health Assessment (KED)
Information patient medical records should include:
Documentation patients received both an eGFR and a uACR test during the measurement year on the same or different dates of service. Documentation should include test date, type and result for both of the following reported annually:
→ At least one eGFR
→ At least one uACR identified by either of the following:
Both a Quantitative Urine Albumin test and a Urine Creatinine test with service dates four days or fewer apart
Or a uACR
Information patient claims should include:
When conducting an eGFR or a uACR in your office, submit a claim using the appropriate codes below. A quantitative urine albumin test and a urine creatinine test must have service dates four days or fewer apart.
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.
