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Provider Update November 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

Access archived Provider Update newsletters and revisit previous articles by visiting our Provider Alerts and Updates page.

General information

How to submit a claim

The preferred way to submit claims is through the Electronic Data Interchange (EDI). Claims can be submitted through your preferred clearinghouse as long as you are a BCBSNE-credentialed provider. If you do not already have a clearinghouse, BCBSNE offers free billing software and support to help you submit claims electronically. Learn more about the Electronic Data Interchange and PC-ACE Software.

If circumstances necessitate submitting claims on paper temporarily, please inform your Provider Advocate. Their information can be found on NebraskaBlue.com. 

This notification will enable us to prepare for the receipt of paper claims and help mitigate any potential downstream delays.

Medical

Reminder: Choose the right form for formulary exception requests

As shared on Happening Now and NaviNet on Oct. 2, 2026, the preferred way to submit a formulary exception request is electronically through CoverMyMeds or the online preauthorization form.

If submitting a formulary exception request by fax, use the appropriate Formulary Exception Form based on the member’s benefit plan:

To help avoid delays, please complete all required information before submitting the form. Incomplete forms will be returned.

Preauthorization requests must be submitted online through CoverMyMeds or the online preauthorization form. Preauthorization requests faxed using a Formulary Exception Form will be returned.

New Prior Authorization Transparency Requirements Coming in 2027

Effective Jan. 1, 2027, BCBSNE will implement federal interoperability and prior authorization transparency requirements under the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F). BCBSNE will publish annual prior authorization metrics, maintain information regarding services requiring prior authorization and make available educational resources related to health information exchange initiatives. For more information, visit the CMS Interoperability and Prior Authorization Final Rule webpage. 

At this time, no action is required from providers. Additional details will be shared in upcoming provider communications prior to the Jan. 1, 2027 effective date.

Dental

Enhanced Dental Benefits program begins Jan. 1, 2027
As previously announced in the October 2026 issue of Provider Update, Blue Cross and Blue Shield of Nebraska will launch its Enhanced Dental Benefits program for eligible dental plan members effective Jan. 1, 2027.
The program supports whole-person health by providing enhanced preventive dental coverage for eligible members with certain medical conditions. The October article included information about eligible health conditions and available enhanced benefits.

Reminder for providers

Beginning Jan. 1, 2027, please verify members' eligibility and plan benefits before providing services. Enhanced dental benefits vary based on the member's health condition and plan design. Confirming benefits in advance helps ensure eligible members receive the appropriate coverage and preventive services available through the program.

For complete program details, including eligibility requirements and enhanced benefits by health condition, refer to the October 2026 issue of Provider Update.

Security Corner

Small Clinics, Big Targets
Many clinics assume cybercriminals only go after large hospitals, but that's not always the case. Attacks on physician groups and specialty clinics have risen noticeably, and attackers increasingly target practices with fewer security resources that still hold valuable patient data.

Take these simple steps to help protect your clinic and your patients:
  • Know what you run. Keep a list of the software and devices your clinic uses.
  • Patch promptly. Install updates as soon as they're available or confirm your IT vendor does.
  • Retire what you don't use. Software you no longer use but haven't removed can stay open to attackers for years.

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 subscribe to BCBSNE provider emails to receive notifications when new Provider Update newsletters are published. Provider Update newsletters are part of your provider agreement and may contain important operational, administrative and policy updates.

To ensure you receive these communications, keep your contract and contact information current with BCBSNE.

Add a New Team Member to Our Email List

If you have a new team member who would like to join our email list, they can subscribe using the same sign-up page as our Provider Updates newsletter, Alerts & Updates for Providers.

Sign up

This newsletter serves as an amendment to your agreement as a contracting Blue Cross and Blue Shield of Nebraska healthcare provider and affects your contractual relationship with us.

Blue Cross and Blue Shield of Nebraska is an independent licensee of the Blue Cross Blue Shield Association. The Blue Cross Blue Shield Association licenses Blue Cross and Blue Shield of Nebraska to offer certain products and services under the Blue Cross® and Blue Shield® brand names within the state of Nebraska.

NaviNet® and Availity are healthcare provider portals providing services for Blue Cross and Blue Shield of Nebraska. 
Evolent™ is an independent company that provides utilization management services through RadMD® for Blue Cross and Blue Shield of Nebraska, an independent licensee of the Blue Cross Blue Shield Association.

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