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Provider Update September 2025
Jump to section:General Information | Medicare Advantage | Medical: CommercialFEP | Behavioral Health | Security
Welcome to our new Update Newsletter format where information for our medical, dental and Medicare Advantage products is included in one publication.
General Information
Action needed: Preauthorization submissions transition to digital-only in November 2025
To streamline administrative workflows, improve processing timeliness and enhance overall care delivery efficiency, Blue Cross and Blue Shield of Nebraska (BCBSNE) will transition to accepting preauthorization requests exclusively through our digital tools starting Nov. 17, 2025. This change applies to medical preauthorization for our commercial lines of business.
Participating providers are expected to use NaviNet®, our provider portal, for their preauthorization submissions.
For out-of-network and providers outside of Nebraska, a new online form will be available beginning Nov. 1, 2025.
Action Items:
- Register for NaviNet if you haven’t already
- Continue monitoring Happening Now and
- our Provider Bulletin for updates
As part of this transition, we will be retiring the commercial preauthorization fax lines on Nov. 17, 2025:
- Medical (Outpatient): 1-800-255-2838 or 402-392-4141
- Radiology: 1-800-991-5644 or 402-982-8644
- Commercial Pre-Cert (Inpatient):
- 800-821-4788/402-343-3444 and 1-866-422-5120
Note: If you submit faxes prior to the Nov. 17 transition, you will receive messaging on your fax response notifying you of the upcoming change.
Fax lines remaining unchanged for medical records:
- Medical records for Appeals (submission of Appeals through the provider portal is preferred)
- 888-492-4944
- 402-548-4684
- Medical records for Commercial
- 402-392-4111
- 800-991-7389
Important: These fax lines are for medical records only. If preauthorization requests are sent to these numbers, they will not be processed, and providers will receive a faxed response indicating the request was misrouted.
Note: Medicare Advantage (MA) providers are encouraged to continue using the provider portal. The retiring fax lines apply only to commercial lines of business. MA fax lines are not affected and will remain in use as usual.
We appreciate your partnership as we move toward more efficient, digital-first solutions to support you and your patients. For help getting started, visit the NaviNet FAQs in the Provider Academy.
Weekly claim payment schedule change effective Nov. 1, 2025
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 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 MA 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 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.
BCBSNE partners with Conduent to enhance payment accuracy for ED claims
As announced on Happening Now and in our July issue of the Provider Bulletin, 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.
Sign up for NaviNet
Registration is free; all you need is a Federal Tax ID. All participating BCBSNE health care and dental providers can enroll for access.
If your office is already using NaviNet, please contact your Security Officer to create a NaviNet account for you. If you do not have a NaviNet account, please visit Register.NaviNet.net to begin the registration process.
Medicare Advantage
Timely filing reminder for MA claims
While MA claims were previously allowed a 12-month timely filing window, contracts administered by BCBSNE include a 120-day filing requirement.
The provider procedure has been updated to accurately reflect this contractual requirement. Please ensure that all clean MA claims are submitted within 120 days of the date of service, or within the timeframe outlined in your provider agreement.
Provider announcement: Clarification regarding auto-approval process for skilled nursing facility stays Effective Aug. 1, 2025
This announcement, posted on MA Happening Now on July 22, 2025, 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) 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 three days will apply only to MA Participating (PAR) Skilled Nursing Facilities
- Consistent with the policy, swing bed stays are not eligible for auto-approval (regardless of how authorizations may have been processed in the past)
- Providers must follow the required notification and review steps to maintain eligibility: MA Auto Approval for SNF Admissions - MA-X-093
- Effective Nov. 1, 2025, auto-approval will change from seven days to three days
Reminder of requirements
Notification of admission
- Must be submitted within 72 hours of admission
- Preferred method: Submit via NaviNet to initiate authorization and enable continued stay review access
- Alternative methods:
- Fax: 1-866-422-5120
- Phone: 1-877-399-1671
Concurrent authorization review
- 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.
Billing for anesthesia services: Centers for Medicare & Medicaid Services (CMS) modifier requirements
Accurate billing for anesthesia services is essential for compliance and reimbursement, particularly when submitting data to under CMS guidelines.
CMS requires that anesthesia modifiers be listed first in the claim data sequence. These modifiers include:
- QZ – CRNA service without medical direction by a physician
- AA – Anesthesia services performed personally by an anesthesiologist
- QS – Monitored anesthesia care service
Following the anesthesia modifier, any physical status modifiers should be listed second. These typically include:
- P1 – A normal healthy patient
- P2 – A patient with mild systemic disease
- P3 – A patient with severe systemic disease
- (and others as applicable)
Proper sequencing ensures that claims are processed correctly and that providers are reimbursed appropriately. Failure to follow this order may result in claim rejections or delays.
For billing teams and providers, it's important to review internal systems and workflows to ensure that modifier sequencing aligns with CMS requirements.
Medical: Commercial and FEP
Upcoming changes to preferred biologic medications: Humira and Stelara (effective Jan. 1, 2026)
Starting Jan. 1, 2026, we will be removing Humira and Stelara from the following prescription drug lists: NetResults Performance, TraditionalRxList, ValueRxList and BluePride RxChoices. There are multiple biosimilar options available which are, in many cases, interchangeable with Humira or Stelara and will work the same.
Affected medications:
- Humira (adalimumab) and Stelara (ustekinumab)
- Humira:
- Adalimumab-aaty
- Adalimumab-adaz
- Hadlima
- Simlandi
- Stelara:
- Selarsdi
- Steqeyma
- Yesintek
- Starting Jan. 1, 2026: Patients currently on Humira or Stelara will need to switch to a preferred biosimilar alternative for treatment.
- New therapy patients: Patients new to therapy will need to use a preferred biosimilar agent, per policy.
- Preauthorizations: Current preauthorizations extending beyond Jan. 1, 2026, will be transitioned to the biosimilar equivalent medication. Upon expiration, a new preauthorization request for the biosimilar medication will be required as is required today.
Note: These changes do not apply to MA members or members using other BCBSNE prescription drug lists.
Behavioral Health
Narrow network participation guidelines offer expanded opportunities for mental health providers
Health care providers across Nebraska have new opportunities to join select narrow networks, with expanded access for fully licensed mental health professionals and continued availability for credentialed providers in most counties.
Premier Select BlueChoice (PSBC)
Mental health providers who are fully licensed and credentialed are now eligible to apply for participation in PSBC across all Nebraska counties — including Douglas and Sarpy. Please note that provisional providers are not eligible for narrow network participation.
For specialties outside of mental health, Douglas and Sarpy counties remain closed to new applicants. However, fully credentialed providers in all other Nebraska counties are welcome to apply.
Blueprint Health Network
Managed by CHI Health Partners, Blueprint Health Network offers a streamlined application process. Interested providers should apply directly through CHI Health Partners using the Network Participation Request form.
Medicare Advantage Network
This network remains open to all fully credentialed providers across all counties. As with other networks, provisional mental health providers are not eligible for participation.
How to apply for a narrow network
Providers can apply using the Advanced Provider Inquiry (API) tool in NaviNet. Follow these steps:
- Navigate to the Advanced Provider Inquiry section.
- Select “Narrow or MA Network Request” from the dropdown menu.
- Indicate your interest by checking the box for Premier Select BlueChoice and/or Medicare Advantage.
For a step-by-step guide, view the API tool eLearning video.
These updates reflect our ongoing commitment to improving access and streamlining participation for qualified providers. We encourage eligible professionals to take advantage of these opportunities to better serve their communities.
Security Corner
Payment redirection
Keep an eye on your clinic’s receivables — the money owed to you by a payor. If receivables start going consistently long, there’s the risk that payments could have been illegally redirected by cyber criminals. Contact the payor immediately if you notice this trend.