Medicare’s Annual Enrollment Period is happening now, and many Medicare beneficiaries are evaluating their health coverage for the next plan year. Deciding between Medicare Advantage and Original Medicare coverage is an important and complex choice. There’s a lot of information available, but unfortunately, it’s not all true. Blue Cross and Blue Shield of Nebraska (BCBSNE) developed a Medicare Advantage fact sheet that addresses common misconceptions about Medicare Advantage plans. To learn more, visit the Provider FAQs.
Please be sure you are using the reconsideration form for coordination of benefits (COB), workers’ compensation and subrogation adjustments instead of a timely filing override request.
If you are notified by another carrier that a member’s Blue Cross and Blue Shield (BCBS) insurance is primary, you should submit a reconsideration form with the primary recoupment or denial. Do not send a timely filing override request; it will not be returned and could impact claim processing.
Beginning Jan. 1, 2024, we will no longer return the incorrectly filed requests. You will be responsible for correctly submitting the COB, workers’ compensation and subrogation adjustments.
Contacting BCBSNE
As of Nov. 1, 2023, providers are being directed to NaviNet® for self-service for all member eligibility and benefits, preauthorization/precertification, claim, reconsideration, and appeal needs.
In the event that the needed information is not available on NaviNet:
Review our Happening Now page to see if there is a known issue
For missing remittance advice (RA), reach out to your clearinghouse for the information (as applicable)
Fax the completed form to the number on the bottom of the form
You will not be able to track the status of this form online. Please allow 45-60 days for a response.
*Pre-service appeals are not part of this process.
Emails or notes on forms indicating "Not available on NaviNet", without providing any further details, will not be addressed.
Claims denied with code MP27
Final determination cannot be made until we receive the physician’s office records. The patient’s history and physical, as well as the physician’s notes and/or plan of treatment should not be sent via paper reconsideration form or through the electronic NaviNet submission.
A reconsideration with medical records, either on paper or via the electronic NaviNet submission, will be returned
Providers must fax the medical records with the letter they received from our Medical Support department
Send the letter with the requested records to the correct location (below); otherwise, it will be delayed
Medical Support Department TTY/TDO 711
PO Box 3248 Omaha Fax 402-392-4111
Omaha NE 68180-0001 Toll-Free Fax 800-991-7389
Children’s Nebraska: Children’s Outreach and Provider Education (COPE) program
Children’s Nebraska has launched a new multi-year effort to support Nebraska providers through the Children’s Outreach and Provider Education (COPE) program. COPE provides education, consultation, and resources so primary care providers can more comfortably identify, treat, and manage pediatric mental health conditions seen every day in their practices.
Provider Directory: Make Sure Your Information is Correct
The Consolidated Appropriations Act (CAA) requires that online provider directory information be reviewed and updated if needed, at least every 90 days.
All providers, including dentists, can review directory information in NaviNet. Directory information is located under Practice Documents in NaviNet, updated information will be available on Nov. 27, 2023. Please take a few minutes to review your online directory information to help ensure BCBSNE members can locate your most current information.
For PHO groups handling their own credentialing processes, please continue submitting a full roster every 90 days.
Streamlining the Process for Provider Directory Updates
The federal No Surprises Act of 2021 and the Blue Cross Blue Shield Association require that BCBSNE maintain and update provider directory information within a specified timeframe.
To help ensure continued compliance with these requirements, and to streamline the process of updating our provider directory, BCBSNE will begin using the CAQH (Council for Affordable Healthcare) directory solution, called DirectAssure. DirectAssure works with the CAQH Provider Data Portal, formerly CAQH ProView, enabling providers to submit professional practice information and share it with multiple health plans, limiting administrative work for your office.
In the CAQH Provider Data Portal, you will be able to:
Review, correct, and update information
Confirm information is correct by attesting to its accuracy
Keep information current by updating directory date as changes take place
Attest to the accuracy every 90 days from the last attestation period to indicate the data is still current (will replace the need to review directory information in NaviNet)
Today, over 85% of in-network providers have a CAQH profile. If you do not have a profile, we recommend creating one as soon as possible in preparation for this change. There is no cost associated with this new process. For more information on creating a profile and using the CAQH Provider Data Portal, please visit Proview.caqh.org.
We plan to roll out the new process in early 2024. Additional information and training resources will be available on the Provider Academy. If you are affiliated with a PHO, your Provider Executive Representative will contact you with additional information.
Holiday Hours
On Thursday and Friday, Nov. 23 and 24, Blue Cross and Blue Shield of Nebraska will be closed in observance of the Thanksgiving holiday. Blue Cross and Blue Shield of Nebraska will also be closed on Monday, Dec. 25 and Monday, Jan. 1, in observance of Christmas and New Year’s Day. Please use NaviNet for your eligibility, benefits, and claim status needs during this time.
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 at the same location as our Provider Updates newsletter, Alerts & Updates for Providers.
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.
You are receiving this because you are identified as a provider for Blue Cross and Blue Shield of Nebraska.
