Claims FAQs

What are your Payer IDs?
Professional (including Medicare Advantage):  77780
Institutional (including Medicare Advantage):  00260
Dental: 00760

Can I use any software vendor to connect with Blue Cross Blue Shield of Nebraska?
Third party billing software can be used to submit claims electronically, however, appropriate testing must be done beforehand to ensure no problems will arise during claim submission.

For providers that want to submit claims directly to BCBSNE, but do not already have billing software, BCBSNE does offer free software support with PC Ace (hyper link to PC Ace documentation on site).  This will require a Windows computer as it is not compatible with Macs.  Please be aware we will not offer support or access to our version of PC-Ace to providers who will not be using it to submit claims directly to BCBSNE.  Please contact EDISupport@nebraskablue.com if you are interested in looking at PC Ace as an option.

Can any clearinghouse connect with Blue Cross Blue Shield of Nebraska?
Only clearinghouses approved to be trading partners with Blue Cross Blue Shield of Nebraska can submit claims electronically. Your clearinghouse should be able to advise you if they are already a trading partner with BCBSNE.  If you have a clearinghouse that is not a trading partner with BCBSNE, have them contact EDISupport@nebraskablue.com for more information on how to become a trading partner.

For a provider to be set up with Electronic Remittance Advice (ERA), the provider or clearinghouse needs to submit the ERA Form.  If the provider is filling out the form they will need to get the trading partner number from their clearinghouse.

How will I know if my electronic claim is accepted or rejected? 
Blue Cross Blue Shield of Nebraska offers daily validation reports for electronic claims submitted directly. Please contact your vendor to request access to these reports if you submit claims through a clearinghouse.

What are the most common reasons EDI claims fail to process?

  • Duplicate claim being found already in the system.
  • Medicare primary claims cannot be accepted until 30 days from the adjudication date have passed. If claims are submitted before the 30 days has passed, the claim will reject.
  • Billing Tax ID not found – If this error message displays make sure the Tax ID submitted on the claim is correct and the rendering provider’s NPI is also correct.
  • Taxonomy code is required on all claims or the claim will reject.
  • Membership issues – Make sure that the patient/subscriber name is spelled correctly and that the Member ID is the correct and current one.

Do I need to include the National Provider Indicator (NPI) on my electronic claims?
Yes, all claims should have the NPI number. A provider’s individual NPI number must be submitted under the rendering section on professional and dental claims if separate from the clinic’s NPI. 

How do I know if I need to just re-submit a claim or submit a corrected claim?
If a claim hit an upfront rejection that appears on the validation reports or you received a return letter, the claim can simply be corrected per the error message and be re-submitted.

If a claim passed into our system with no errors and adjudicated, it will need to be submitted as a corrected claim.

How do I submit corrected claims electronically?
Blue Cross Blue Shield of Nebraska requires that a claim sent electronically must also be submitted electronically as a corrected claim. When creating the corrected 837 file, place a value of 5, 7, or 8 in the 2300 CLM 05-3 element as appropriate for the provider.  Enter the original claim number assigned by BCBSNE in the 2300 REF*8 segment.  Looking at the form, these sections would correspond with box 22 for professional or box 4 on an institutional claim.

If an attachment is needed the claim should be dropped to paper and filled out with a reconsideration form.

How do I report National Drug Codes (NDC) codes on EDI claims and encounters?

  1. LIN (Drug Identification) Segment usage
    LIN02 = N4 qualifier for NDC Drug Code
    LIN03 = NDC code in 5-4-2 format.
    Sample: LIN**N4*01234567891~
    Please see the Professional Addenda and the Institutional Addenda for additional usage information.

  2. CPT (Drug Pricing) Segment usage
    CTP04 = Quantity
    CTP05-1 = Unit of Measurement Code values (see below for available list)
    F2 International Unit
    GR Gram
    ML Milliliter
    UN Unit
    Sample: CTP*****2*UN~
    Please see the Professional Addenda and the Institutional Addenda for additional usage information.

Does Blue Cross Blue Shield of Nebraska accept electronic Coordination of Benefits (COB) claims?
Yes.  More information on electronic COB claims can be found here under the EDI Companion Documentation:  ‘BCBSNE 837 Companion Guide for Health Care Claim (Coordination of Benefits)’.

What is the transition process like from paper EOBs to electronic remittance (ERA)?
Providers or their vendors will need to fill out the Electronic Remittance Advice formIf the provider is filling out the form they will need to get the trading partner number from their clearinghouse.

Once the form is received, it is usually processed within 24 to 48 hours or on the next business day.  If the ‘Check here to turn paper off immediately’ box is not checked, paper remits will be turned off after 60 days to allow for adjustment to the transition.  An email confirmation should be received after sign up.  The first electronic remit should be received the week following sign up.

When should I see my electronic remittance (ERA)/I do not see my electronic remittance yet?
Medical:  Remits begin to generate Tuesday nights.

For direct submitters/PC-Ace users, electronic remittance is delivered to be picked up by Friday each week, although they are normally viewable by Thursday.  If it is Thursday and the remits are not yet available, please wait till Friday before reaching out to EDI Support to question whether the remit is missing.

For providers who receive ERA through a vendor or clearinghouse, please reach out to them to find out the delivery times expected.  If a remit is missing or not delivered on time, please reach out to your clearinghouse first to verify if it something in their system.

Dental: Remits begin to generate Thursday nights.  For providers who receive ERA through a vendor or clearinghouse, please reach out to them to find out the delivery times expected.  If a remit is missing or not delivered on time, please reach out to your clearinghouse first to verify if it something in their system.

How does Blue Cross Blue Shield of Nebraska send my ERA to me?
Direct submitters/PC-Ace users can receive their ERA directly from Blue Cross Blue Shield of Nebraska’s Secure File Transfer Protocol (SFTP) website for pickup each week.

Providers who use a vendor or clearinghouse for electronic claims can receive their remits through that clearinghouse via the ERA setup.  BCBSNE will submit the electronic remits directly to the provider’s clearinghouse, who will be responsible for delivering to the provider.

How do I know I am signed up for ERA/EFT?
Once the form has been submitted and processed, you should receive an email confirmation stating the setup has been completed and the effective date if not immediate.  If no email confirmation is received, you can follow up by emailing EDISupport@nebraskablue.com.

Without a paper EOB, how will I know which claims apply to my check/EFT payment?
When an EFT deposit is made, it should still show the check number along with ‘BCBSNE’; this can be compared to the check number found on the remit.  The amount of an EFT should also match with the total amount on the remit.  You must work with your bank if you wish to be notified when EFTs are credited to your account

Can I continue receiving paper EOBs?
After the 60 day transition period (for providers who did not choose to opt out of paper EOBs immediately), paper remits will not be sent. 

Who do I contact if I have issues with Navinet?
If there are questions or concerns regarding member eligibility and claim status, please reach out to our Customer Service department at 800-635-0579.

For questions regarding logging in, access, setting up new users, or navigating the website please reach out to Navinet directly at 888-482-8057.

How often does PC-Ace get updated?
PC-Ace software updates are issued quarterly and PC-Ace users are notified with the update password via the email we have on file. As such, please keep us updated if you change your email address.