When submitting Medicare Advantage (MA) claims, CMS standards must be followed to prevent unnecessary returns and processing delays. Effective June 4, 2024, with the CMS edits in place you will see non-Nebraska MA claims process more appropriately.
Beginning Nov. 26, 2024, we began adjusting claims appropriately prior to June 2024, in accordance with the MA adjustment language. Providers can expect to see these adjustments reflected throughout December 2024 and January 2025.
Please do not submit Reconsideration Requests for claims you believe did not pay correctly. We will be running reports to determine if adjustments or recoupments are needed. Reminder, claim return letters are now available in Plan Documents on NaviNet®.
Below are three common CMS standards that would need to be followed to avoid claims being returned or denied.
DME NU and RR modifiers
Claims that are billing supply codes with NU modifier, and they do not require an NU modifier, will be denied.
If billed without BP and BR modifiers that go with certain rentals, they will be denied as well.
Federally Qualified Health Centers (FQHC) and Rural health claims
Per CMS guidelines Medicare Advantage FQHC and Rural health claims will need to be billed on a UB04 instead of on a CMS 1500 form.
We were not enforcing before and are now and will be returning or denying claims as appropriate.
Ambulance for MA only
Per CMS guidelines, ground mileage totaling up to 100 covered miles must be reported to the nearest tenth of a mile. In addition, all air ambulance mileage must be reported as fractional units to the nearest tenth of a mile. When reporting fractional mileage, providers must round the total miles up to the nearest tenth of a mile.
Professional electronic – When submitting fractional units, the provider needs to submit the same fractional units in the Ambulance Mileage field on the 837P and the units field.
Professional paper (CMS-1500) – When submitting fractional units, the provider needs to submit the fractional units in the units field.
Institutional electronic – When submitting fractional units, the provider needs to submit the fractional unit in the units field. There is not a separate Ambulance Mileage field on the 837I for Institutional.
Institutional paper (UB-04) – Providers should continue to submit whole units as decimals are not allowed on the UB in the units field.
Claims will be returned if not submitted correctly.
Timely Filing Requests transition to NaviNet
Effective Jan. 1, 2025, Blue Cross and Blue Schield of Nebraska (BCBSNE) will no longer accept paper (faxed or mailed) timely filing override requests. As part of our ongoing transition to paperless processes, all timely filing override requests must be submitted via NaviNet.
Please note that we will no longer process or return paper timely filing override requests received via fax or mail.
Urgent radiology preauthorization request line retiring
Effective Jan. 2, 2025, BCBSNE will be retiring the Urgent Radiology Preauthorization Request phone number 402-982-8870 or 888-263-3870.
Please update your records accordingly and direct all future radiology-related inquires via NaviNet. We appreciate your cooperation and understanding.
Reminder: Split-year claim billing
When patient care extends into the new year, following our Split-Year Claim Submission policy ensures your claims are not rejected, returned or delayed due to billing errors.
What is new for the Blue Cross and Blue Shield FEP Service Benefit Plan (FEP SBP) for 2025!
You may have heard about the Postal Service Reform Act of 2022. With this new law, in 2025, there will be a new Postal Service Health Benefits (PSHB) Program. PSHB will offer health insurance to Postal Service employees, retirees and eligible family members starting Jan. 1, 2025.
The Blue Cross and Blue Shield FEP Service Benefit Plan (FEP SBP), we will be supporting employees and annuitants covered under both the Federal Employee Health Benefits (FEHB) program and the Postal Service Health Benefits (PSHB) program.
2025 Benefits for FEHB and PSHB members
For 2025, benefits for Postal Service employees will be equivalent to the benefits for federal employees*. We will continue to offer three plans, FEP Blue Standard, FEP Blue Basic and FEP Blue Focus. The member ID cards will indicate the current enrollment codes for both FEHB and PSHB members:
FEHB
FEP Blue
Focus
FEP Blue
Basic
FEP Blue
Standard
Self Only
131
111
104
Self +1
133
113
106
Self & Family
132
112
105
PSHB
FEP Blue
Focus
FEP Blue
Basic
FEP Blue
Standard
Self Only
35A
33A
33D
Self +1
35C
33C
33F
Self & Family
35B
33B
33E
Please refer to FEPBlue.org for benefit breakdowns for 2025.
*The benefits for both programs will be reviewed on an annual basis going forward.
Changes for FEP Payments, Offsets and Provider Remittance
Starting with claims received Jan. 1, 2025, and after, you may receive up to six checks/EFTs for FEHB and PSHB members. We will continue to issue payments per claim type (professional, and facility/institutional), and each claim will be paid out of one of the three accounts below:
Runout account – Claims for dates of service prior to Jan. 1, 2025, for both federal and postal employees and annuitants, but received after Jan. 1, 2025.
FEHB account – Claims for dates of service Jan. 1, 2025, and after, for federal employees and annuitants.
PSHB account – Claims for dates of service Jan. 1, 2025, and after, for postal employees and annuitants.
What this means:
If you are used to receiving one check/EFT per pay cycle, you may now receive up to three checks/EFTs.
If you are used to receiving two checks/EFTs per pay cycle, you may now receive up to six checks/EFTs.
Immediate offsets and retention refunds will be recouped from the account it was paid from.
Claim payments made prior to Jan. 1, 2025, but determined to be overpaid after Jan. 1, 2025, due to an adjustment, will be offset (or have a refund retention record set up) from the runout account.
Current weekly adjustments that are overpaid will pull the refunded amount first from the current payment that week, followed by overpayments in retention. What this means is refunds in retention may be delayed.
Additional outreach from BCBSNE may be required, outside of our normal offset and retention process, to satisfy refunds owed for payments made from the run-out account.
Providers will continue to receive one remittance per check/EFT payment.
The provider toll-free number is the same for both the FEHB and PSHB plans (800-635-0579).
BCBSNE provider networks are unique and specific to the member’s plan
BCBSNE offers a variety of provider networks to our Nebraska members to ensure access to their preferred providers and to help control costs. Ensuring you are in network for the member’s plan helps ensure the best benefits for your patients. When you are not in the patient’s plan network, their coverage level may be less, or your services may not be covered depending on their plan benefits.
The member’s plan network is identified in the upper right corner on the members ID card. You can also see their plan network when verifying eligibility and benefits in NaviNet under their product details. To learn more about verifying benefits and eligibility in NaviNet, watch our eLearning video.
NEtwork Blue (NB) is our statewide network, made up of 98% of Nebraska’s doctors and 99% of the state’s non-governmental acute care hospitals1
NEtwork Blue provides access to:
Hospitals and clinics across Nebraska
Primary and specialty care providers
Heart, cancer and trauma centers
Children’s care
Behavioral health network
Premier Select BlueChoice (PSBC) is a regional network that features:
Omaha Area
Boys Town National Research Hospital
Downtown and Pacific Street
Children’s Nebraska
Madonna Rehabilitation Hospital Omaha
MD West ONE
Memorial Community Hospital
Midwest Surgical Hospital
Nebraska Medicine
Bellevue Medical Center
Nebraska Medical Center
Nebraska Methodist Hospital System
Methodist Fremont Health
Methodist Hospital
Methodist Jennie Edmundson Hospital
Methodist Women’s Hospital
OrthoNebraska
SecureCare (chiropractors)
Select Specialty Hospital
Affiliated physicians and clinics
Lincoln Area
Beatrice Community Hospital
Bryan Health – East and West
Community Medical Center
Filmore County Hospital
Henderson Community Hospital
Howard County Medical Center
Jefferson County Hospital Center
Johnson County Hospital
Lincoln Surgical Hospital
Madonna Rehabilitation Hospital Lincoln
Mary Lanning Memorial Hospital
Memorial Hospital
Nemaha County Hospital
Pawnee County Memorial Hospital
Saunders Medical Center
SecureCare (chiropractors)
Select Specialty Hospital
Syracuse Area Health
Thayer County Health Services
York General Hospital
Affiliated physicians and clinics
All other Nebraska providers are out of network.
Our Blueprint Health (BH) regional network features CHI Health and other providers and facilities in Nebraska and contiguous counties in Iowa. All other Nebraska providers are out of network.
Some of the key hospitals and health care providers include:
Alegent Creighton Health Services
Boys Town National Research Hospital – Downtown and Pacific Street
CHI Health Creighton University Medical Center – Bergan Mercy
CHI Health Good Samaritan
CHI Health Immanuel
CHI Health Lakeside
CHI Health Mercy Council Bluffs
CHI Midlands
CHI Health Nebraska Heart
CHI Health Planview
CHI Health Richard Young
CHI Health Schuyler
CHI Health St. Elizabeth
CHI Health St. Francis
CHI Health St. Mary’s
Children’s Nebraska
Lasting Hope Recovery Center
Lincoln Surgical Hospital
MD West ONE
Nebraska Spine Hospital LLC
SecureCare (chiropractors)
Affiliated physicians and clinics
Medicare Advantage (MA) Network: provides BCBSNE MA members access to over 6,000 providers across all specialties in the state of Nebraska. All BCBSNE MA members have access to the same robust network of providers in the MA Network regardless of the plan they are enrolled in.
If you are not sure which network(s) you are contracted for please visit our Find a Doctor tool.
For quick access, we added a link in NaviNet in the Resources section.
After locating your provider, clinic or facility, you will see the Plans accepted in the fourth column. Click on the link here and then on the Medical and Dental Plans drop-down menu to see the list of networks.
For more information on Verification of Enrollment, please review our general policy.
1 Source BCBSNE statistics, Oct. 17, 2023
Reminder: Emailing Provider Executives
Emails are handled in the order received; however, emails are not processed unless the below information is included.
Provider name, NPI and TIN
Claim numbers (if applicable)
Member name and ID
DOS
Expected outcome or reimbursement
Additionally, the appropriate steps MUST be followed BEFORE submitting an escalation request to this email box:
Step One: NaviNet
Please access NaviNet for all member, claim, authorization and appeal needs. If you do not have access to NaviNet please register by following the steps at Provider Academy.
Step Two: Contact
If NaviNet is unsuccessful, please use the claims investigation tool located in NaviNet.
Step Three: Escalating
For claim escalation needs that you are unable to resolve through NaviNet or Customer Service Claims (CSC) Investigation, you can email this email box and include why NaviNet or Claims Investigation was not successful. You should also include the inquiry number from Customer Service.
For fee schedules:
All fee schedules are available in NaviNet and will no longer be available via CSC, email or inquiry.
If you are affiliated with a PHO, you must obtain the fee schedule from the PHO.
For timely filing:
Please submit your request via NaviNet using the Timely Filing form.
Please remember: Coordination of Benefits (COB) is not a member ID exception. Please complete the reconsideration form on NaviNet if another insurance was billed, recouped or denied the claim and you then submitted to BCBSNE.
Provider Executives no longer address COBs submitted incorrectly on a timely filing form.
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.
