BCBSNE Provider News

Benefits for epinephrine (effective July 1, 2017)

Posted June 1, 2017

As part of our effort to provide our members with quality and cost-effective health care coverage, we are making a change to epinephrine benefits.

Benefits are available under our group and individual members’ plans for the authorized generic of EpiPen® and EpiPen Jr® (epinephrine injection). The price of the authorized generic of EpiPen and EpiPen Jr is significantly lower than the price of the brand.

Because of the availability of the authorized generic versions of EpiPen and EpiPen Jr, effective July 1, 2017, benefits for the brand name versions will not be available. In addition, please note that benefits for the brand Adrenaclick® and its authorized generic will not be available.

PLEASE NOTE: Prescriptions must be written for the authorized generic of EpiPen and EpiPen Jr (epinephrine solution auto-injector manufactured by Mylan) in order to ensure our members have access to covered epinephrine.

Walk at Lunch Day is Wednesday, April 26

Posted April 11, 2017

Make a pledge to walk at lunch for 30 minutes! Mark your calendars for BCBSNE’s Eleventh Annual National Walk at Lunch Day on April 26, 2017! Join thousands of Nebraskans from across the state in this fun event. Visit nebraskablue.com/walk for more information and to register.

Important information about coverage of Auvi-Q®

Posted March 16, 2017

BCBSNE health plan helps our members save money on prescriptions. One way we do this is by providing cost-effective options to help lower the out-of-pocket cost to our members. On Feb. 14, 2017, the drug company Kaleo reintroduced the epinephrine injection Auvi-Q® to the market highlighting $0 out-of-pocket cost for all commercially insured patients, including high deductible plans. Pricing strategies like this one encourage our members to ask their doctors to prescribe seemingly low-cost medications like Auvi-Q. What members may not realize is this strategy also includes a very high cost to their insurance plan providing health care coverage to its subscribers. In the long term, this drives up the premiums the insurance carrier must charge its members.

We want to provide the best options for our members’ health and financial wellbeing. Other epinephrine injection medications are available that are equally as effective as Auvi-Q but at a much lower cost. When prescribing epinephrine injections to your patients, please consider all the available drug choices. We will handle claims for the epinephrine auto-injector Auvi-Q as follows:

  • Pre-ACA individual and small group members: prior authorization required
  • ACA individual and small group plans: not covered
  • Large group plans (fully-insured and self-funded): not covered

If you have questions, please email ProviderSolutions@nebraskablue.com. We appreciate your help in providing the best possible service for your patients.

Checking claims status, effective March 1, 2017

BCBSNE is proud to work with our provider network to serve our members, your patients. In an effort to enhance our service, BCBSNE has identified an opportunity to improve the customer service experience for providers calling with urgent or complex issues. Effective March 1, 2017, Provider Services will not receive medical or dental claims inquiries by phone. Instead, providers will be directed to the following self-service resources.

  • Phone: The Intelligent Voice Recognition (IVR) system provides claims status details, such as denied claims with the remit date or claim returned status. To use the system, you will need your NPI number, tax ID, patient’s date of birth and patient’s identification number.
  • Online:
    • NaviNet: Sign up or log in to NaviNet, your online provider portal. Note: Dental claims status cannot be obtained on NaviNet.
    • Nebraskablue.com/contact: Requests for claims information that cannot be obtained via the IVR system or NaviNet, including Medicare cross over claims, should be submitted via nebraskablue.com/contact. Click on the “Check a Claim Status” link and complete and submit the form. Inquiries will be answered within five business days.
  • Other resources:
    • Inspect the electronic claims rejection report from your clearinghouse
    • Review return letters
    • Assess remittance advice

Magellan's 2017 Holiday Schedule

NIA (National Imaging Associates, Inc.) Magellan, BCBSNE's Spine Pain Management prior authorization program vendor, is available 24/7 at radmd.com. The call center will be closed on these days:  

Monday, Jan. 2 New Year’s Day (observed)

Monday, May 29 Memorial Day

Tuesday, July 4 Independence Day

Monday, Sept. 4 Labor Day

Thursday, Nov. 23 Thanksgiving Day

Friday, Nov. 24 Day After Thanksgiving

Monday, Dec. 25 Christmas Day

Download the Current Version of the Policies & Procedures Manual

The Blue Cross and Blue Shield of Nebraska Policies and Procedures Manual for NEtwork BLUE Health Care Providers/Facilities has been updated and is available for download.

Single Sign on Now Available through NaviNet!

At Blue Cross and Blue Shield of Nebraska, we continue to seek ways to make it easier for providers to deliver the best care to our members.

As part of an update to our NaviNet provider portal, we are happy to introduce a single sign on enhancement that will provide direct, more convenient access to the following vendor program websites:

  • Radiology Quality Initiative through American Imaging Management (AIM)
  • Spine Pain Management Program through NIA Magellan/RadMD 

As part of this new feature, providers can simply log into NaviNet and click on “Spine Pain Management Prior Authorization” and “AIM Diagnostic Imaging Request,” and they will automatically be logged in – no additional user names or passwords needed!

Note: AIM users may have to recreate their favorites within NaviNet’s single sign on account.

Log in to NaviNet today to try the single sign on feature!

Not on NaviNet? Learn more and sign up today! 

The advantages of using NaviNet include:
  • Check current member claim status – no need to pick up the phone!
  • Quickly access member eligibility and benefits information
  • Access pre-service review information for out-of-area members. 

We understand the workloads you encounter every day and recognize the need for administrative efficiencies. If you have any questions about this new feature or about NaviNet in general, please contact NaviNet at (617) 715-6000.

Providers Are Responsible for Recredentialing

All BCBSNE professional providers are required to undergo recredentialing every three years. The purpose of the recredentialing process is to re-attest a provider’s good standing with state license, valid insurance and other touch points that were required for initial acceptance into the network.

If you or other members of your office staff receive a recredentialing request, do not delay taking the requested action. A lack of response to our recredentialing requests will ultimately result in a provider being terminated from the BCBSNE PPO network.

When a provider’s recredentialing is due, BCBSNE’s online credentialing partner, the Council for Affordable Quality Healthcare (CAQH), notifies the provider that they need to visit CAQH PROVIEW  to either complete the online application or update the application and attest it (if the provider has previously completed the CAQH application).

Any communications from CAQH are delegated through BCBSNE. CAQH makes no distinction between initial credentialing and re-credentialing, as monitoring the application completion process is CAQH’s main role. Once the application and/or attestation are complete, CAQH will notify BCBSNE via a weekly roster that the provider has satisfied the application process.

If the provider does not respond to the re-credentialing request after one month, BCBSNE will send a reminder letter. If the request goes unanswered after two months, a third and final certified letter will be sent to the provider advising that they will be terminated from the BCBSNE network if they do not respond within two weeks.

It is important to note that the application is not complete until you have been officially notified by CAQH. For information on the steps and list of items you will need to complete the re-credentialing process, refer to page 3 of the CAQH Universal Provider Datasource’s Quick Reference Guide at bit.ly/10v7u2O

For additional information on BCBSNE’s recredentialing process and helpful tools, visit our Credentialing page, and be sure to review the CAQH credentialing steps within the “How It All Fits Together” section.

Important Information: Feb. 2015 Anthem Data Breach

Anthem Inc., the country's second-largest health insurance company and a Blue Cross and Blue Shield affiliate operating in 14 states, has reported a data breach that could affect 80 million of its customers and employees.

Personal information was obtained from Anthem's current and former members, including names, birthdays, member identification (ID) and/or Social Security numbers, street addresses, email addresses and employment information, including income data. No medical or financial data (including credit card data) was obtained.

It is important to remember that Blue Cross and Blue Shield of Nebraska is a separate company from Anthem. Based on what we know today, this data breach has not impacted any of BCBSNE's systems. BCBSNE takes particular care to safeguard our members' personal and medical information, and we have extensive data security measures and continuous monitoring in place to deter events such as this.

BCBSNE is working with Anthem to determine the impact on BCBSNE members, and will work together to help those members as more information becomes available. If any BCBSNE members used medical care in one of Anthem's service areas, their information might be compromised. BCBSNE will work with Anthem to notify impacted members in the coming weeks.

Anthem members who may be impacted include members from these plans: Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Georgia, Empire Blue Cross and Blue Shield, Amerigroup, Caremore, Unicare, Healthlink, and DeCare. Some of those impacted members may live in Nebraska.

Members with concerns are being encouraged to go to www.anthemfacts.com or call (877) 263-7995 for more information. Anthem is offering free credit monitoring and identity protection services to impacted members.

If you have any questions, please contact your BCBSNE health network consultant.

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.