We want to let you know about an upcoming change to our weekly batch claim payment schedule that will go into effect Nov. 1, 2025. We wanted to give you advance notice so you can analyze and prepare for the short-term impact this change will likely have on your organization.
Starting Nov. 1, each weekly batch claims payment will be comprised only of claims with receipt dates of at least 21 days. We are also shifting the weekly payment settlement date from Thursdays to Mondays. This change applies to all Blue Cross and Blue Shield of Nebraska (BCBSNE) lines of business, excluding the Federal Employee Program (FEP).
We are making this change to reduce the need for post-payment corrections, which causes an administrative burden for providers and confusion for patients. In addition, we are subject to audits and validations to demonstrate accuracy for much of our government business, including Medicare Advantage and ACA plans. Making this change ensures we have sufficient time to review and validate claims prior to payment.
This new payment cadence supports our ability to continue to provide you with timely payment in alignment with industry standards. Other carriers’ payment cycles range from 21-45 days.
Illustration of difference between current and new payment schedules
Short-term impact of payment cycle change
Because only claims with receipt dates of 21 days or more will be included in each weekly batch, it should be anticipated that for the first three weeks of the new schedule, your organization’s reimbursement amount will be lower than previous weeks until the new cycle aligns with the adjusted cadence.
Improving the efficiency of our payments to you, as well as making interactions with the health care system less complicated and confusing for our members, are among our top priorities. If you have any questions about this upcoming change, please email Provider Partnership Director Dana Medeiros at Dana.Medeiros@NebraskaBlue.com with the subject line, Payment Schedule Change.
Final reminder: Transition to electronic remittance advices and payments
As part of BCBSNE’s continued efforts to streamline operations and reduce paper usage, we are reminding all providers that the transition to electronic remittance advices and payments is rapidly approaching. The deadline is Oct. 1, 2025 — action is required now to avoid disruptions.
Paper remittance advices will be discontinued effective Oct. 1, 2025. Providers must begin receiving 835s through a clearinghouse or by accessing remittance advices in NaviNet®.
Paper checks will no longer be an option after Oct. 1, 2025. Providers currently receiving paper checks must complete the electronic funds transfer (EFT) form to continue receiving payments.
Forms are available on NaviNet. Visit the Administrative Updates/Secure Forms section to access the necessary forms for EFT and electronic remittance advice enrollment. Please complete these steps as soon as possible.
Dentist exception: Dentists who are unable to enroll with a clearinghouse may continue receiving paper remittance advices due to limited self-service options in NaviNet.
Time is running out: Providers who do not complete the transition by the deadline may experience delays in payment and remittance delivery.
Coming soon: ERA forms transitioning to hyperlink-based submissions
We’re streamlining the submission process for Electronic Remittance Advice (ERA) forms!
Please keep an eye on Happening Now for the official launch date. Once the hyperlink is live on the Find a Form page, providers should begin to use this link and discontinue using the PDF right away.
After 30 days from the link going live, any PDF submissions will be returned with instructions to submit via the new hyperlink method. These submissions will no longer be processed.
We appreciate your attention to this change and your continued partnership in making this transition smooth and successful.
Submit appeals and reconsiderations faster with NaviNet
We’ve made it easier to submit appeals, timely filing requests and reconsiderations through NaviNet. As of June 26, 2025, you’ll now select a reason instead of a “type,” simplifying the process and improving efficiency.
Why submit through NaviNet?
Instant confirmation: Know your request was received the moment you submit it — no waiting, no wondering.
Real-time visibility: Track the status of your submission directly in NaviNet. No need to call or fax for updates.
Faster routing: Your request is automatically directed to the correct department, reducing delays and rework.
Streamlined process: A new update lets you select a reason for your request instead of a “type,” making submissions faster and more intuitive.
Paper-free convenience: Eliminate printing, faxing and mailing — submit everything digitally, including supporting documents in PDF format.
Built-in security: NaviNet lets you securely send appeals and medical records using HIPAA-compliant tools.
How to submit:
Go to your claim status details
Click Appeal and choose a reason
Add notes, attach PDFs and submit
Make the switch today — NaviNet is faster, easier and more efficient.
BCBSNE partners with Conduent to enhance payment accuracy for ED claims
At BCBSNE, we are committed to ensuring appropriate reimbursement and supporting high-quality, cost-effective care. As part of this effort, we’re partnering with Conduent, a trusted leader in health care operations, to conduct coding reviews of Emergency Department (ED) claims. While we understand that claim reviews may not always be welcome news, this partnership is intended to support consistency and accuracy in reimbursement.
Starting Sept. 1, 2025, Conduent will begin reviewing ED claims to determine the appropriate level of reimbursement based on the diagnosis and services billed. This initiative is designed to align with industry standards and promote accurate, fair payment for services rendered.
What providers can expect
The ED claim review process focuses on promoting billing accuracy and fairness.
If a claim is selected for review, you will receive a letter identifying notifying you of the overpaid claim(s) along with a detailed explanation of why the claim is overpaid. The review process will follow our standard contractual lookback period, typically 12 months. Reviews will include all lines of business.
You may choose to appeal, following the steps in the letter. Medical records may be requested if they have not already been submitted to BCBSNE. We are working closely with Conduent to minimize these requests and streamline the process for providers.
About Conduent
Conduent is a Business Associate of BCBSNE, as defined under HIPAA (45 CFR §160.103), and will perform its responsibilities in full compliance with HIPAA requirements. With deep expertise in health care operations, Conduent supports payers and providers in improving outcomes, reducing costs and enhancing operational efficiency.
Your partnership matters
We appreciate your cooperation in providing Conduent with the necessary medical and/or financial information to complete these reviews. Requests will follow the same methods previously used by BCBSNE, including mail, fax and EMR access.
Thank you for your continued partnership and commitment to delivering quality care to our members. Please share this information with your teams as appropriate.
Reminder: Use the advanced provider inquiry form after claim investigation
If your claim questions or concerns are not resolved through the NaviNet Claim Investigation inquiry, providers are encouraged to use the Advanced Provider Inquiry form for further assistance.
Important: The Claim Investigation process must be completed first, as the resulting reference number is required when submitting the form. Please note that the NaviNet NPS number is not considered a valid CSC reference number. If a request requires a reference number, it must come from a phone call or a completed Claims Investigation. Submissions without a valid reference number will be returned without review.
When completing the form, select the appropriate subject from the “Nature of Inquiry” dropdown menu to ensure your request is routed to the correct team. Be sure to enter a valid email address to receive your reference number immediately after submission.
For more guidance, please view the Advanced Provider Inquiries eLearning module.
Provider announcement: Clarification regarding auto-approval process for skilled nursing facility (SNF) stays
Effective Aug. 1, 2025
This announcement is intended to clarify the purpose and intent of BCBSNE’s policy regarding auto-approval for SNF admissions which was initially posted Dec. 6, 2024, and effective Jan. 1, 2025.
The policy only applies to participating (PAR) Medicare Advantage (MA) providers
It does not apply to non-participating providers or to swing bed stays
The auto-approval period is being adjusted from seven to three days
BCBSNE is updating its systems to ensure consistent and accurate application of the policy
What to expect:
Auto-approval of the first seven days will apply only to MA Participating (PAR) SNFs
Consistent with the policy, swing bed stays are not eligible for auto-approval (regardless of how authorizations may have been processed in the past)
Required to certify additional days beyond the initial seven
Effective Nov. 1, this will change to certification beyond the initial three days
Ensures timely issuance of the Notice of Medicare Non-Coverage to both the facility and the member
If you are faxing medical records, please send by noon on the due date to maintain review timeliness
We appreciate your cooperation. This clarification is designed to support a more consistent, accurate and efficient application of the policy and overall authorization process. Thank you for your continued partnership.
Correction to Comprehensive MA Physical Exam claim denials
We are notifying you that claims submitted for Comprehensive Physical Exams (CPEs) billed with CPT codes 99381–99397 were erroneously denied for MA members due to a system configuration issue.
Issue resolution:
The error has been identified and corrected. Impacted claims have been reprocessed and adjusted as of this week. Providers should begin seeing updated adjudication results in their remittance advice.
Next steps for providers:
No action is required for resubmission of affected claims. Please reimburse members if there was a cost-share collected that should not have been.
If you believe a claim was missed or not adjusted correctly, please submit an Advanced Provider Inquiry.
We apologize for any inconvenience this may have caused and appreciate your continued partnership in delivering quality care to our members.
Reminder: MA reimbursement
In order to obtain proper reimbursement for MA claims, please follow Original Medicare billing and coding guidelines. This information can be found at CMS.gov, searching for the appropriate topic.
Benefits of telehealth visits from Telescope Health for your practice
Telehealth, a method of delivering health care services remotely using telecommunications technology, allows patients to consult with health care providers via video calls, phone calls or online messaging, making health care more accessible and convenient. Starting April 1, 2025, BCBSNE transitioned its employee health plan telehealth provider to Telescope Health, enhancing the telehealth experience for both patients and providers. Effective July 1, 2025, the following groups also transitioned to Telescope Health: Behlen Manufacturing Co., Metropolitan Utilities District (MUD) and Nebraska Association of County Officials (NACO). All other groups will transition on Jan. 1, 2026.
As a primary care provider, you play a vital role in your patients' health. When your patients receive telehealth visits from Telescope Health providers, your practice can benefit in several ways:
Enhanced care coordination: Telescope Health providers share detailed visit notes and recommendations with you, ensuring seamless continuity of care for your patients.
Reduced workload: Telehealth visits help manage patient volume, allowing you to focus on more complex cases or in-person visits.
Improved patient outcomes: Timely telehealth interventions address urgent health issues, preventing complications and improving overall patient health.
Access to specialized expertise: Telescope Health providers offer specialized knowledge or services that complement your care plan, enhancing the quality of care you provide.
Efficient use of resources: Telehealth reduces unnecessary hospital visits and admissions, optimizing health care resources and reducing costs for your practice.
Patient satisfaction: Patients appreciate the convenience and accessibility of telehealth, leading to higher satisfaction and adherence to treatment plans, which benefits your practice.
These benefits collectively support you in providing comprehensive, efficient and high-quality care to your patients.
Note: Not all BCBSNE members have access to this offering. It is important for providers to refer to their patients' specific benefits plans to determine eligibility and coverage.
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They can sign up for Provider updates online in the same location as our Provider Updates newsletter on the Alerts and Updates page.
