Medicare Advantage
We're excited to announce that in 2025, operations of our Medicare Advantage (MA) program are fully in house.
The information on this page is available for those providers who are Medicare Advantage-contracted with Blue Cross and Blue Shield of Nebraska (BCBSNE).
For Commercial and FEP updates please reference the Happening Now page.
Stay up-to-date with the changes in the Provider Update Newsletter. Read more »
For Medicare Advantage eligibility, benefit or claims questions call 888-505-2022. *
Important Information and MA Happening Now Updates
Beginning August 1, 2025, BCBSNE MA claims for readmissions will follow the CMS guidelines denying the second readmission.
Please view the MA Readmission Quality Program procedure for more information.
At Blue Cross and Blue Shield of Nebraska, we are committed to working with our provider community as partners in health care.
Our new Reimagine Preauthorization page will keep you updated on how we're improving our preauthorization processes. Check back often to stay informed on the changes that matter most to you.
Together, we're reimagining the future of preauthorizations.
To ensure timely and accurate processing of Medicare Advantage (MA) dental claims submitted on behalf of members, please use the official 2025 Dental Reimbursement Form, available under the Provider MA Forms page on NebraskaBlue.
Kindly discontinue the use of outdated ADA claim forms. Utilizing the correct and current form helps streamline the reimbursement process and significantly improves turnaround times.
Blue Cross and Blue Shield of Nebraska (BCBSNE) is committed to transparency and keeping our providers informed. We are reaching out to notify you of significant changes and updates to the CMS RADV auditing process. Your support in providing medical records will be crucial as we navigate these changes.
Key Update:
On May 21, 2025, CMS announced a dramatic expansion of its RADV audit program that will affect all Medicare Advantage plans. This represents the most significant change to RADV auditing in the program's history.
What's Changed:
- Annual Audits: CMS will now audit all eligible MA contracts annually (previously ~60 contracts per year).
- Increased Sample Sizes: Audit sample sizes will increase from 35 to up to 200 member records per contract.
- Expedited Completion: CMS is expediting the completion of all audits for Payment Years 2018-2024 by early 2026.
- Expanded Workforce: The agency is expanding its medical coder workforce from 40 to 2,000 coders by September 2025.
- Enhanced Technology: Enhanced AI technology will be deployed to identify potentially unsupported diagnoses.
Although these audits are on the Medicare Advantage Organization, upon request, BCBSNE will need your support in providing medical records.
Thank you for your continued partnership and cooperation.
*MA Provider CSC hours of operation: Monday- Friday from 8 a.m. to 7 p.m.
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