Provider Newsletter

As a contracting Blue Cross and Blue Shield of Nebraska health care provider, the newsletters serve as amendment to your agreement and affects your contractual relationship with us. You are encouraged to file every issue within your BCBSNE Policies and Procedures manual and reference it often.

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November 2017 (pdf)

In this issue:
  • Changes in Reimbursement
  • Regional Provider Meeting
  • Vitamin D, when to test
  • New ID card – Blueprint Health Network
  • Reminder of the Medicare Advantage newsletter

September 2017 (pdf)

In this issue:
  • Changes in Reimbursement
  • Going Green - revision of notification of newsletter updates
  • Lack of Information Requests
  • New ID card – Blueprint Network
  • Risk adjustment medical record retrieval
  • Non FDA-approved Drugs
  • Reminder about CPT II billing guidelines for blood sugar monitoring lab services

July 2017 (pdf)

In this issue:
  • UPDATE: Reimbursement for multiple surgical procedures during one surgery
  • Billing guidelines for the Kyleena IUD, effective July 1, 2017
  • Electronic payment options
  • New coordination of benefits provision
  • Billing guidelines clarification: Return claims
  • Benefits for epinephrine, effective July 1, 2017
  • Submitting claims for gender neutral patients
  • Updates to the Clear Coverage for radiology preauthorizations
  • Revised process: preauthorization for radiology services
  • Access your third quarter ASP schedule on NaviNet
  • Apply HCPCS code J3490 carefully for efficient claim processing
  • NaviNet claim status inquiry: Terminated providers
  • New prefixes for member ID cards coming in 2018
  • Update newsletter: Revision to postcard notification
  • ICD-10 medical record documentation best practices
  • REMINDER: Medicare Advantage Update newsletter
  • REMINDER: Medical policy updates
  • REMINDER: Provider Relationship Managers

May 2017 (pdf)

In this issue:
  • Debby Synowicki joins BCBSNE as provider relationship manager
  • Denials for urgent and not medically necessary prospective and concurrent reviews
  • Auvi-Q coverage
  • Reimbursement for implant codes
  • Reimbursement for CPT and HCPCS codes without allowances
  • Update to medical policy for power wheelchairs
  • Risk adjustment data validation audit
  • Upcoming webinars in the risk adjustment series
  • Verifying eligibility for non-Nebraska Blue Cross and Blue Shield members
  • Timely claim filing
  • Reminder: Place of service
  • New: Medicare Advantage Update newsletter
  • Reminder: Provider Relationship Managers
  • Reminder: Medical policy updates

March 2017 (pdf)

In this issue:
  • Site of service for professional reimbursement
  • Reimbursement for multiple surgical procedures during one surgery
  • Access 2017 fee schedules through NaviNet
  • Reminder: check claims status
  • Risk adjustment data validation audit
  • Update to medical policy for home sleep studies
  • CPT II billing guidelines for blood sugar monitoring lab services
  • Coming soon: HEDIS medical record requests
  • Timely filing limit for Mosaic member claims
  • Coding prophylactic fluoride administration
  • Important information about coverage of Auvi-Q®
  • What you need to know: Precertification and preauthorization requirements for BCBSNE members
  • Best practices for completing the appeal/reconsideration request form

January 2017 (pdf)

In this issue:
  • Medicare Advantage
  • Reimbursement available for Star measure: conducting medication reconciliation post-discharge (MRP)
  • CPT II billing guidelines for blood sugar monitoring lab services
  • Day One Precertification for out-of-state BlueCard® members
  • 2017 benefit changes for the Federal Employee Program
  • GY modifier no longer applies to BCBSNE secondary policies
  • Maternity billing: transfer of care
  • Outpatient rehabilitation: billing for timed units
  • Miscellaneous surgical supply not payable
  • Breast tomosynthesis now payable
  • New percentage rates on reduced and discontinued services starting April 1, 2017
  • Co-existing conditions
  • Researching claim status
  • Provider addresses—mailing, billing and physical
  • Customer Service Center no longer providing copies of remits
  • Reminder: CIOX requests for medical records
  • Reminder: medical policy updates
  • Reminder: referrals
  • Reminder: 1099 tax forms

November 2016 (pdf)

In this issue:
  • Preauthorization of echocardiography not required as of Oct. 1, 2016
  • BCBSNE Medical Policy tool tips
  • BCBSNE provider networks
  • Highlighting HEDIS®
  • BCBSNE risk adjustment methodology
  • Risk adjustment medical record retrieval
  • Writing prescriptions
  • Edits for lab panels (professional and facility)
  • Trading Partner Agreements
  • Day One Precertification Review program
  • Researching claim status
  • Retraction: “Reminder: Returned Claims Must Be Refiled as New”
  • Miscellaneous Surgical Supply not payable

September 2016 (pdf)

In this issue:
  • New guidelines for Medicare Secondary preauthorizations
  • BCBSNE provider networks
  • Radiology authorization requests through Clear Coverage
  • Delegated credentialing: what you need to know
  • FEP billing guidelines for Residential Treatment Centers
  • Highlighting HEDIS®
  • Electronic claim return
  • Split claims
  • Professional 837P claims
  • Modifier usage
  • Use Med Policy Blue for preauthorization requests
  • BlueBoard Reminder: Medical Policy updates
  • BlueBoard Reminder: Ambulance pick-up
  • BlueBoard Reminder: The difference between a reconsideration and an appeal
  • BlueBoard Reminder: Purchase a copy of ICD-10, 10th edition
  • BCBSNE recognizes hospitals in Nebraska for delivering quality, affordable maternity care
  • Upcoming webinar series: 2016 risk adjustment
  • Retraction: June 2016 Update article “Submit One Claim when Providing Services on the Same Date”

June 2016 (pdf)

In this issue:
  • New Gold Card Program for Prior Authorizations
  • BlueBoard: No ICD Indicator on Paper Claim? Check Your 1500 Form
  • BlueBoard: Submit One Claim When Providing Services on the Same Date
  • BlueBoard: Procedure for Noting Antepartum Dates of Service
  • BlueBoard: Billing for Total OB Care, 59400 and 59510: Use the Date of Delivery
  • BlueBoard: Filing Paper Claims
  • BlueBoard: Report Non-Covered Miles on the Ambulance Claim
  • BlueBoard: Returned Claims Must Be Refiled as New Claims
  • BlueCard Bulletin: Contiguous County Claim Filing Reminder
  • Highlighting HEDIS®
  • Provider Effective Date Cannot be Retroactive
  • Important Reminder: Subrogation and Third Party Payers
  • Pharmacy Preauthorization Necessary to Avoid Patient Abrasion

March 2016 (pdf)

In this issue:
  • Always Refer Patients to BCBSNE Network Providers
  • Avoid Unnecessary Delays—Guidelines for Submitting Invoices with ASC Claims
  • Electronic Claims and Taxonomy Codes
  • New Format for Refund Request Letters
  • Drug Price Increases
  • BlueBoard Reminder: Returned Claims Must Be Refiled as New
  • BlueBoard Reminder: Form 1099
  • BlueBoard Reminder: Interqual® SmartSheets
  • BlueBoard Reminder: Re-credentialing
  • CAQH Helpful Hints for Completing Your Application
  • Medical Policy Updates for 1st Quarter 2016
  • Medical Policy Change to Digital Breast Tomosynthesis
  • Highlighting HEDIS®
  • BlueCard® Bulletin: Blue Cross and Blue Shield of Alabama Begins Select
  • Oncology Program with AIM Specialty Health (AIM), Effective April 1, 2016
  • BlueCard® Bulletin Reminder: BlueCard Billing Guidelines

January 2016 (pdf)

In this issue:
  • Researching Claims Status with NaviNet - Effective Jan. 1, 2016
  • BlueBoard: Opioids - The Prescription Drug & Heroin Overdose Epidemic
  • BlueBoard: Helpful Ways You Can Assist In Timely Processing of Medical Records
  • BlueBoard: Going Green - Paper Remittance Advice Mailings
  • BlueBoard: Billing Administration Codes
  • BlueBoard: Change in Prefix for BCBSNE Employees and Dependents
  • BlueBoard: Reminders to Note
  • Risk Adjustment Outreach
  • Transgender (Gender Identity) Claims
  • For Your Information: Drug Price Increases
  • HEDIS®
  • BlueCard® Bulletin: Anthem Expanded Cardiology Program
  • Claim Filing for Contiguous County Area Providers
  • Magellan Prior Authorizations for Interventional Pain Management or Spine Surgery
  • 2016 Federal Employee Program Benefit Changes

Archives

HEALTH INSURANCE TERMS


COINSURANCE

The percentage of the bill you pay after your deductible has been met.

COPAY

A fixed amount you pay when you get a covered health service.

Tiered benefit plan

A health care plan featuring multiple levels of benefits based on the network status of a particular provider. 

DEDUCTIBLE

The annual amount you pay for covered health services before your insurance begins to pay.

emergency care services

Any covered services received in a hospital emergency room setting.

SUBSTANCE ABUSE DISORDER SERVICES

Includes behavioral health treatment, counseling, and psychotherapy


in-network provider

A provider contracted by your insurance company to accept an agreed upon payment for covered services. 

OUT-OF-network provider

A term for providers that aren’t contracting with your insurance company. (Your out-of-pocket costs will tend to be more expensive if you go to an out-of-network provider.)

out-of-pocket

Your expenses for medical care that aren’t reimbursed by insurance, including deductibles, coinsurance and co-payments.

penalty

If you can afford health insurance, but choose not to buy it, you must have a health coverage exemption or pay a tax penalty on your federal income tax return.

premium

The amount you pay to your health insurance company each month. 


Preventive services

Health care services that focus on the prevention of disease and health maintenance.

rehab SERVICES

Services and devices to help you recover if you are injured or have surgery. This includes physical, occupational and speech therapy.

special enrollment period

The time after the Open Enrollment Period when you can still purchase health insurance only if you have a qualifying life event (losing other health coverage, having a baby, getting married, moving).

specialist

A physician who has a majority of his or her practice in fields other than internal or general medicine, obstetrics/gynecology, pediatrics or family practice.