Medicare Advantage

BCBSNE offers a variety of Medicare Advantage plans to support member needs.

The information on this page is available for those providers who are Medicare Advantage-contracted with BCBSNE.

Stay up-to-date with the changes in the Provider Update Newsletter. Read more »                 

Quick Links to Resources

Medicare Advantage Policies

  • Medicare Advantage Policies and Resources
  • Prior Authorization Lists and Policies for Medical and Part B Drugs
  • Quality Quick Tip Sheets
  • Forms

Medicare Advantage Plans 
 
Medicare Advantage FAQs

Provider Contacts

For Medicare Advantage eligibility, benefit or claims questions call 888-505-2022.

Important Information and Updates

Effective January 1, 2024, Carelon will add the following new code to prior authorization. This is a new CPT code for 1/1/2024.

Carelon Code Description

 

When submitting Medicare Advantage claims, providers will need to ensure:

  • Rendering NPI number is not populated in box 24J / 837 loop 2310B segment NM1 and/or 2420A segment NM1 if the number is the same as the billing NPI
    • If a provider is a sole proprietor – only submit the NPI in box 33A / 837 loop 2010AA segment NM1
    • If a claim is submitted with the same NPI in both box 24J and 33A the claim will reject
  • Submit claims for prefixes YMA and Y2M with a street address in the billing address field, claims submitted with PO boxes will reject
  • Host claims will return when the facility ZIP codes is missing from Box 32

1st Level Appeals:

BCBSNE Provider Correspondence
PO Box 21501
Eagan, MN 55121

Fax: 210-579-6930

2nd Level Appeals:

BCBSNE Appeals & Grievances
PO Box 21831
Eagan, MN 55121

Fax: 1-877-482-9749

For additional information regarding Nebraska Medicare Advantage plans, refer to the Medicare Advantage policy page.