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Provider Update October 2026
Welcome to your Provider Update newsletter, your source for important updates and information about our commercial medical and dental plans. A separate Provider Update newsletter for Medicare Advantage providers will be published soon. Watch your email for notification when it becomes available.
What's inside
| General Information |
Claim acknowledgement enhancement effective Jan. 1, 2027 Coming in 2027: BCBSNE provider portal transitioning to Availity |
| Medical: Commercial and FEP |
|
| Clinical, Authorization and Appeals |
Home healthcare prior authorization update now in effect Prior authorization required for hip, knee and shoulder surgeries effective Nov. 1, 2026 Provider Notice: Prior authorization process for CPT® 92133 |
General information
Claim acknowledgement enhancement effective Jan. 1, 2027
Blue Cross and Blue Shield of Nebraska (BCBSNE) is making an important improvement to claim acknowledgement processing by transitioning all trading partners to the industry standard 277CA (Claim Acknowledgement) transaction.
Claim Confirmation Reports will continue to be delivered as they are today through Dec. 31, 2026.
Beginning Jan. 1, 2027, the 277CA will replace Claim Confirmation Reports and become the single, standardized claim acknowledgement.
This enhancement brings greater consistency and clarity to claim status messaging. The 277CA has been widely adopted across the industry since 2012 and is designed to deliver more accurate, reliable information about claim acceptance and rejection. Standardizing on this transaction supports automated workflows, reduces variations created by custom formats and helps ensure predictable processing for providers and vendors.
This update is part of our ongoing EDI modernization efforts and aligns with current clearinghouse and platform requirements.
What this means for you
- A single, standardized claim acknowledgement format
- Clear, consistent acceptance and rejection details
- Reduced reliance on custom reports
This change applies to all trading partners submitting electronic claims. Providers and vendors should ensure their systems are ready to receive and process 277CA transactions by Jan. 1, 2027.
We appreciate your partnership as we continue investing in improvements that support efficient and reliable claims processing.
Coming in 2027: BCBSNE provider portal transitioning to Availity
Providers can look forward to several enhancements, including:
- Submit claims electronically and attach supporting documentation (PDFs) through the portal
- Enhanced claim status information, including additional details related to denials
- Expanded correspondence access, with more letters available and improved search capabilities
- Expanded secure messaging functionality for provider inquiries and communications
- Direct links to authorization resources and portals
- Access to a multi-payer platform, allowing providers to work with multiple health plans through a single portal. Registered users will simply add Blue Cross and Blue Shield of Nebraska to their existing Availity account
What will stay the same?
While the access point is changing from NaviNet to Availity, providers will continue to have access to many of the same resources they use today, including:
- Eligibility and benefits information
- Claim status inquiries
- Authorization resources
- Provider inquiries and communications
- Provider documents and resources
What to expect
The transition is planned for the second quarter of 2027. Additional details, including registration information, training opportunities, timelines and support resources, will be shared in future provider communications as the launch date approaches.
Stay tuned to Happening Now, the Provider Update newsletter and other BCBSNE provider communications for the latest information.
Medical: Commercial and FEP
Clinical, Authorization and Appeals
Home healthcare prior authorization update now in effect
As previously announced in a Happening Now post on Sept. 1, 2026, prior authorization is no longer required for the first 20 home healthcare visits for members enrolled in commercial plans.
Home healthcare providers may deliver up to 20 visits without submitting a prior authorization request. Prior authorization is required beginning with the 21st visit.
This change streamlines the authorization process and supports timely access to care for members receiving home health services. Providers should ensure their authorization workflows reflect the updated requirement.
Summary of changes
Effective date: Oct. 1, 2026
- Applies to: Commercial plans
- No prior authorization required: Visits 1-20
- Prior authorization required: Beginning with visit 21
Prior authorization required for hip, knee and shoulder surgeries effective Nov. 1, 2026
As previously announced on Happening Now in August and in the September 2026 Provider Update newsletter, prior authorization will be required for select hip, knee and shoulder surgical procedures for all employer group plans effective Nov. 1, 2026. Evolent™ will perform prior authorization reviews for these services.
The following procedures require prior authorization under Medical Policy III.277
| Procedure | CPT code(s) |
| Revision/Conversion Hip Arthroplasty |
27132, 27134, 27137, 27138 |
| Total Hip Arthroplasty/Resurfacing |
27130, S2118 |
| Femoroacetabular Impingement (FAI) Hip Surgery |
29914, 29915, 29916 |
| Hip Surgery – Other |
29860, 29861, 29862, 29863 |
| Revision Knee Arthroplasty |
27486, 27487 |
| Total Knee Arthroplasty (TKA) |
27447 |
| Partial-Unicompartmental Knee Arthroplasty (UKA) |
27446, 27438 |
| Knee Manipulation under Anesthesia (MUA) |
27570, 29884 |
| Knee Ligament Reconstruction/Repair |
27405, 27407, 27409, 27427, 27428, 27429, 29888, 29889 |
| Knee Meniscectomy/Meniscal Repair/Meniscal Transplant |
27332, 27333, 27403, 29868, 29880, 29881, 29882, 29883 Knee Surgery – Other 27412, 27415, 27416, 27418, 27420, 27422, 27424, 27425, 29866, 29867, 29870, 29873, 29874, 29875, 29876, 29877, 29879, 29885, 29886, 29887, G0289 |
| Revision Shoulder Arthroplasty |
23473, 23474 |
| Total/Reverse Shoulder Arthroplasty or Resurfacing |
23472 |
| Partial Shoulder Arthroplasty/Hemiarthroplasty |
23470 |
| Frozen Shoulder Repair/Adhesive Capsulitis |
29825 |
| Shoulder Labral Repair |
23450, 23455, 23460, 23462, 23465, 23466, 29806, 29807 |
| Shoulder Rotator Cuff Repair |
23410, 23412, 23420, 29827 |
| Shoulder Surgery - Other |
23120, 23125, 23130, 23405, 23415, 23430, 23700, 29805, 29819, 29820, 29821, 29822, 29823, 29824, 29825, +29826, 29828 |
Submit prior authorization requests
- Call Evolent at 1-866-972-9642 between 7 a.m. and 7 p.m. CST (8 a.m. to 8 p.m. EST)
- Submit requests online through RadMD
Thank you for your partnership in providing quality care to our members.
Prior authorization no longer required for CPT® 92133
Effective Sept. 1, 2026, BCBSNE removed prior authorization and medical review requirements for CPT® 92133. Providers no longer need to submit authorization requests before performing services billed under this code.
Removing this requirement simplifies administrative processes and supports timely access to care. Providers may continue to order and perform services as clinically appropriate without obtaining prior authorization.
Key changes
- Effective date: Sept. 1, 2026
- Prior authorization: No longer required for CPT® 92133
- Medical review: No longer required for CPT® 92133
- Provider action: No authorization submission is needed for this service
This change reflects BCBSNE's continued focus on reducing administrative burden and improving the provider experience while supporting quality care for members.
Thank you for your partnership
Dental
Enhanced Dental Benefits program expands coverage for eligible members Jan. 1, 2027
Beginning Jan. 1, 2027, BCBSNE will offer an enhanced dental benefits program for eligible dental plan members. The program supports whole-person health by providing additional preventive dental services for members with certain medical conditions.
Research continues to demonstrate the connection between oral health and overall well-being. Eligible members may qualify for enhanced preventive dental benefits if they have one of the following conditions:
- Cancer-related chemotherapy and/or radiation
- Diabetes
- High-risk cardiac conditions
- Kidney failure or dialysis
- Periodontal (gum) disease
- Pregnancy
- Suppressed immune systems
Depending on the member's health condition and dental plan benefits, enhanced coverage may include additional professional cleanings and fluoride applications.
Enhanced benefits by health condition.
| Health condition | Enhanced benefit |
| Cancer-related chemotherapy and/or radiation | Four cleanings per year and fluoride application* |
| Diabetes |
Four cleanings per year and fluoride application* |
| High-risk cardiac conditions | Four cleanings per year |
| Kidney failure or dialysis | Four cleanings per year |
| Periodontal (gum) disease |
Four cleanings per year and fluoride application* |
| Pregnancy |
One additional cleaning |
| Suppressed immune systems | Four cleanings per year and fluoride application* |
* Coverage remains the same, with one enhancement: an additional fluoride treatment when fluoride is covered under the member's dental plan. There are no age requirements, and the benefit may apply to the subscriber, spouse or covered dependents.
Supporting oral and overall health
By expanding access to preventive dental services, the Enhanced Dental Benefits program helps support oral health, encourage early intervention and promote overall well-being for eligible members.
Reminder for providers
Effective Jan. 1, 2027, please verify members' eligibility and plan benefits before providing services. Enhanced dental benefits vary by health condition and plan design, and reviewing benefits in advance helps ensure eligible members receive the appropriate coverage.
Sign up for NaviNet®
Registration is free and requires only a Federal Tax ID. Participating BCBSNE healthcare and dental providers are eligible to enroll for access.
If your office already uses NaviNet, contact your Security Officer to set up your account. If your office does not use NaviNet, visit Register for NaviNet to begin the registration process.
Stay informed with BCBSNE provider communications
Log in to NaviNet Plan Central and sign up for BCBSNE provider emails to receive notifications when new Provider Update newsletters are available. Provider Update newsletters are an extension of your provider contract and may include important operational, policy and administrative information. Be sure your contract and contact information are current so you receive timely updates and communications from BCBSNE.