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
As part of our ongoing efforts to strengthen operational resilience, we will be conducting maintenance on some systems on Saturday, Aug. 16, 2025.
Please be advised that system access may be unavailable from 6:00 a.m. to 6:00 p.m. CST. This includes potential interruptions to services and functionality within the provider portal.
We recommend planning accordingly to minimize any disruption to your operations. Normal service is expected to resume promptly after maintenance is completed.
If this update continues outside of the expected hours, a new update will be posted on Happening Now and NaviNet Plan Central.
Thank you for your understanding and continued partnership.
We are notifying you that claims submitted for Comprehensive Physical Exams (CPEs) billed with CPT codes 99381–99397 were erroneously denied for Medicare Advantage members due to a system configuration issue.
Issue Resolution:
The error has been identified and corrected. Impacted claims have been reprocessed and adjusted as of this week. Providers should begin seeing updated adjudication results in their remittance advice.
Next Steps for Providers:
No action is required for resubmission of affected claims.
If you believe a claim was missed or not adjusted correctly, please submit an Advanced Provider Inquiry.
We apologize for any inconvenience this may have caused and appreciate your continued partnership in delivering quality care to our members.
In order to obtain proper reimbursement for Medicare Advantage (MA) claims, please follow Original Medicare billing and coding guidelines. This information can be found at CMS.gov, searching for the appropriate topic.
We want to let you know about an upcoming change to our weekly batch claim payment schedule that will go into effect Nov. 1, 2025. We wanted to give you advance notice so you can analyze and prepare for the short-term impact this change will likely have on your organization.
Starting Nov. 1, each weekly batch claims payment will be comprised only of claims with receipt dates of at least 21 days. We are also shifting the weekly payment settlement date from Thursdays to Mondays. This change applies to all Blue Cross and Blue Shield of Nebraska (BCBSNE) lines of business, excluding the Federal Employee Program (FEP).
We are making this change to reduce the need for post-payment corrections, which causes an administrative burden for providers and confusion for patients. In addition, we are subject to audits and validations to demonstrate accuracy for much of our government business, including Medicare Advantage and ACA plans. Making this change ensures we have sufficient time to review and validate claims prior to payment.
This new payment cadence supports our ability to continue to provide you with timely payment in alignment with industry standards. Other carriers’ payment cycles range from 21-45 days.
Illustration of difference between current and new payment schedules
Short-term impact of payment cycle change
Because only claims with receipt dates of 21 days or more will be included in each weekly batch, it should be anticipated that for the first three weeks of the new schedule, your organization’s reimbursement amount will be lower than previous weeks, until the new cycle aligns with the adjusted cadence.
Improving the efficiency of our payments to you, as well as making interactions with the health care system less complicated and confusing for our members, are among our top priorities. If you have any questions about this upcoming change, please email Provider Partnership Director Dana Medeiros at Dana.Medeiros@NebraskaBlue.com with the subject line, Payment Schedule Change.
Beginning Aug. 1, 2025, BCBSNE MA claims for readmissions will follow the CMS guidelines denying the second admission.
Please view the MA Readmission Quality Program procedure for more information.
Effective Aug.1, 2025
This announcement is intended to clarify the purpose and intent of BCBSNE’s policy regarding auto-approval for SNF admissions which was initially posted Dec. 6, 2024, and effective Jan. 1, 2025.
- The policy only applies to participating (PAR) Medicare Advantage providers
- It does not apply to non-participating providers or to swing bed stays
- The auto-approval period is being adjusted from seven (7) to three (3) days
- BCBSNE is updating its systems to ensure consistent and accurate application of the policy
What to Expect:
- Auto-approval of the first seven days will apply only to MA Participating (PAR) Skilled Nursing Facilities
- Consistent with the policy, swing bed stays are not eligible for auto-approval (regardless of how authorizations may have been processed in the past)
- Providers must follow the required notification and review steps to maintain eligibility - MA Auto Approval for SNF Admissions - MA-X-093
- Effective Nov. 1, 2025, auto-approval will change from 7 days to 3 days
Reminder of Requirements
Notification of Admission
- Must be submitted within 72 hours of admission
- Preferred method: Submit via NaviNet to initiate authorization and enable continued stay review access
- Alternative methods:
- Fax: 1-866-422-5120
- Phone: 1-877-399-1671
Concurrent Authorization Review
- Required to certify additional days beyond the initial seven
- Effective November 1, this will change to certification beyond the initial three days
- Ensures timely issuance of the Notice of Medicare Non-Coverage to both the facility and the member
- If you are faxing medical records, please send by noon on the due date to maintain review timeliness
We appreciate your cooperation. This clarification is designed to support a more consistent, accurate and efficient application of the policy and overall authorization process. Thank you for your continued partnership.
For BCBNE Medicare Advantage members with the YMA4 or Y2M4 prefix, timely filing denial appeals must be submitted using the Appeal option in NaviNet. Please be advise that paper submissions will not be reviewed.
This process is the same as the one currently used for commercial members.
Providers can now view 2024 MA claims through the Claim Status tool in NaviNet.
To access claim details, please use the member’s 2024 ID number, which includes one of the following four-letter prefixes:
- YMAN
- Y2MN
Using the correct member ID ensures accurate claim lookup and helps streamline your workflow.
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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