EDI FAQs

General Questions

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 setup with ERAs with a clearinghouse approved to be a trading partner, the provider or clearinghouse needs to fill out the Electronic Remittance Advice Form found on our website under the Forms for Providers section.  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 validation reports for electronic claims submitted directly to us. 

 

Read more about the types of EDI reports provided.

 

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 that the Tax ID submitted on the claim is correct and that 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 go to our website and find the Forms for Providers link and fill out the Electronic Remittance Advice form.  If 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’ time to allow for adjustment to the transition.  An email confirmation should be received for the signup.  The week following signup will normally be the start of the first electronic remit delivery.


When should I see my electronic remittance (ERA)/I do not see my electronic remittance yet?

 

Medical:  Remits begin to be generated 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 be generated 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 long does it take to enroll in EFT/how soon will I receive my EFT payments?

 

While processing the EFT form usually takes no more than 24-48 hours during business days, the EFT payment start dates are not effective immediately.  EFT payment setups first have to go through bank verification timelines which will push the EFT start date until the 1st of the following month.  However if it is far enough into a month, it may be pushed out to the 1st of the month following that (for example if form is received and setup on 2/28, the EFT effective date will not be until 4/1 to allow for bank verification times).

 

After the EFT form has been received and processed, the provider should receive an email confirmation that will state what the effective date is for the EFT payments to start.

 

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 a timeframe for 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?

 

Providers who are receiving ERA can only have the option to continue receiving paper EOBs for a transition period of 60 days if the ‘Check here to turn paper off immediately’ box is not checked on the Electronic Remittance Advice form.  After this transition period, paper remits will not be permitted to be sent for ERA setup. 

 

Who do I contact if I have issues with Navinet?

 

If there are questions or concerns regarding membership eligibility and claim status, please reach out to our Customer Service department at 1-888-592-8961. .

 

For questions regarding logging in, access, setting up new users, or navigating the website please reach out to Navinet directly at 1-888-482-8057.

 

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 to contact with.  As such please keep us updated if you change your email address.

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.