Happening Now

Please ensure you are submitting TIN/NPI of providers who are credentialed with BCBSNE. Most importantly, do not submit claims for newly-credentialed providers until you have the acceptance letter with the provider’s effective date.

For credentialing guidance, please visit NebraskaBlue.com/Credentialing or the Administrative Updates/Secure Forms link on the BCBSNE NaviNet landing page.

If the TIN or NPI have changed, refer to the Changes of address, telephone number and/or tax identification number, or adding practice locations policy.

Please be sure to add the appropriate modifiers as this additional information helps to make sure your claim gets paid correctly for the services rendered.

Modifiers indicate that a service or procedure performed has been altered by some specific circumstance, but not changed in its definition or code. They are used to add information or change the description of service to improve accuracy or specificity. Keep in mind that the use of modifiers should always follow the guidelines set by the American Medical Association (AMA) and other relevant coding authorities. 

As a reminder, the Consolidated Appropriations Act (CAA) requires that certain provider directory information be verified every 90 days. BCBSNE participating providers are required to verify and attest to the accuracy of their information in the CAQH Provider Data Portal. The information must be attested to every 90 days, even if the data has not changed since last verified.

Under the CAA, BCBSNE is required to remove providers from our directory whose data we are unable to verify. If you do not complete the attestation in CAQH, and we are unable to verify your information, you may be removed from the directory.

For more information about verifying your information in CAQH, please visit CAQH Provider Data Portal.

For PHO groups handling their own credentialing processes, please continue submitting a full roster every 90 days.

When submitting an appeal, it is crucial to select the correct Appeals Request Form instead of the Reconsideration Request Form. Using the incorrect form can lead to delays and prevent your request from being processed by the appropriate team.

By utilizing NaviNet, you can easily choose the correct form, ensuring a smoother and more efficient appeals process.

For out-of-network providers, the Appeals Request Form is readily available on our Provider Forms NebraskaBlue page.

Our preauthorization portal on Navinet^® will be undergoing scheduled maintenance and you will be unable to submit or view authorizations online during this update. Below is the timeframe of this outage.

• Start: 11:00 p.m. CST, Friday, March 7
• End: 9:30 a.m. CST, Saturday March 8

If timeliness allows, please submit your authorization outside of the affected hours. If services need to be requested during the hours of the update, please fax to the numbers below.

Commercial members

• Acute Inpatient or Post Acute admissions fax line: 402-343-3444
• Outpatient services fax line: 402-391-4141

Medicare Advantage members

• Acute Inpatient or Post Acute admissions fax line: 1-866-659-0165
• Outpatient services please FAX to 1-877-399-1671

If this update continues outside of the expected hours, a new update will be posted on NaviNet Plan Central.

We are pleased to inform you of an important update to our Radiology/Imaging policy that will benefit your practice and your patients. As of March 15, 2025, policy IV.81 has been revised to streamline access to essential health services. This change does not apply to our Medicare Advantage plans.

Key Update:

These CPT codes will no longer require preauthorization or medical review for our commercial plans.

• 78451 - Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic)
• 75452 - Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection
• 78453 - Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic)
• 78454 - Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection

What This Means for Your Practice:

• Simplified Process: You can now perform Myocardial perfusion imaging without the need for preauthorization or medical review, allowing you to provide timely care to your patients.
• Reduced Administrative Burden: This change minimizes the paperwork and administrative tasks associated with preauthorization, enabling you to focus more on patient care.
• Enhanced Patient Outcomes: By facilitating easier access to this important screening tool, we aim to support early detection and better health outcomes for your patients.

We are committed to continuously improving our services and policies to better support your practice. If you have any questions or need further assistance, please do not hesitate to contact our provider support team. Thank you for your continued partnership and dedication to patient care.

Starting May 1, 2025, BCBSNE will implement a new and improved policy for e-consultation services, aimed at streamlining processes and enhancing provider efficiency. This policy update reflects BCBSNE’s commitment to supporting healthcare providers with clear and effective guidelines.

Guidelines for Consulting Providers:

• Utilize procedure codes 99446-99449, 99451, or G0546-G0550 when billing for medical consultations.
• Avoid billing for e-consultation services if a face-to-face encounter with the patient has occurred within the last 14 days.

Guidelines for Requesting Treating Providers:

• Use procedure codes 99452 or G0551.
• These services can only be reported once every 14 days.

Submission Guidelines:

• Apply the Place of Service code that indicates your location when providing the service.
• Note that e-consultation services with Place of Service codes 02 or 10 will be denied.

This policy update is designed to ensure clarity and consistency in billing practices, ultimately benefiting both providers and patients. BCBSNE is dedicated to facilitating seamless and efficient healthcare delivery through these enhanced guidelines. Providers are encouraged to familiarize themselves with these changes to ensure compliance and optimize their e-consultation services.

We are pleased to inform you of an important update to our Radiology/Imaging policy that will benefit your practice and your patients. As of Feb. 15, 2025, policy IV.81 has been revised to streamline access to essential health services. This change does not apply to our Medicare Advantage plans.

Key Update:

• Procedure Code 71271: Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s), has been removed from the policy. This means that this procedure no longer requires preauthorization or medical review.

What This Means for Your Practice:

• Simplified Process: You can now perform low-dose CT scans for lung cancer screening without the need for preauthorization or medical review, allowing you to provide timely care to your patients.
• Reduced Administrative Burden: This change minimizes the paperwork and administrative tasks associated with preauthorization, enabling you to focus more on patient care.
• Enhanced Patient Outcomes: By facilitating easier access to this important screening tool, we aim to support early detection and better health outcomes for your patients.

InterQual Update:

• The InterQual criteria for commercial plans have been updated to reflect this change, ensuring that our guidelines are aligned with the latest policy revisions.

We are committed to continuously improving our services and policies to better support your practice. If you have any questions or need further assistance, please do not hesitate to contact our provider support team. Thank you for your continued partnership and dedication to patient care.

Identity theft is a growing concern in healthcare, where sensitive personal and medical information is handled daily. Implementing robust identity theft precautions is crucial to safeguard patient information and maintain trust. One effective practice is verifying photo IDs, which plays a significant role in preventing identity theft and ensuring accurate patient identification.

Benefits of Photo ID Verification

• Accurate Patient Identification: Ensures the person receiving care is the patient on record, reducing medical errors.
• Enhanced Security: Adds an extra layer of security, making it harder for individuals to use stolen identities.
• Improved Trust and Confidence: Patients feel more secure knowing their information is protected, building trust in the provider-patient relationship.

By incorporating these measures into your daily operations, you can significantly reduce the risk of identity theft and enhance the overall patient experience.

We kindly request that you share this information with your respective teams, as necessary.

Issue:

•  The problem occurs when OOS providers submit authorizations through Availity to their local payer.
• The system fails to recognize the prefix, redirecting them to the Florida Blue Landing page.
• However, when they initiate the authorization process from the landing page, the system attempts to perform an eligibility check (which should be disabled) and requests a Provider Assigned Payer ID (PAPI), which OOS providers do not possess.
• This results in the process failing.

Cause:

• This issue is a result of UI changes implemented in Availity last year.
• We are actively collaborating with Availity to resolve this problem in production.
• A definitive date for a full fix is still being discussed and determined.

Next Steps:

• We are working closely with Availity to resolve this issue as soon as possible.
• In the meantime, OOS providers experiencing this issue should call the phone number on the back of the member's ID card to submit their authorization requests.

Effective Jan. 1, 2024, Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs) can independently bill Medicare for services related to the diagnosis and treatment of mental illnesses. Medicare Part B will reimburse MFTs and MHCs at 75% of the rate paid to clinical psychologists under the Medicare Physician Fee Schedule.

Important Information for Providers:

1. Medicare Opt-Out Status: If you have opted out of Medicare, please be aware that Blue Cross Blue Shield of Nebraska (BCBSNE) requires an affidavit from Medicare confirming your opt-out status with each claim submission. Without this affidavit, your claims will be denied for Medicare Explanation of Benefits (EOB).
2. Opt-In Opportunity: We encourage MIDA providers to consider opting in to Medicare, as you now have the ability to do so. This change allows you to expand your services to Medicare beneficiaries and streamline your billing process

Please ensure that you are familiar with these updates and take the necessary steps to comply with the new requirements.

Marriage and Family Therapists & Mental Health Counselors

We are excited to share an important update regarding the verification of coverage for our members. With our recent enhancements, you can now accurately verify coverage using just the member’s name and date of birth. This means you no longer need the prefix and Card ID number to confirm active membership with our BCBSNE members.

We appreciate your attention to detail in ensuring our members receive the best service possible. Thank you for your continued dedication and support.

We are thrilled to announce a major win for our provider community! Effective Jan. 10, 2025, BCBSNE will no longer require preauthorization for the following codes related to continuous positive airway pressure (CPAP) devices:

• E0601
• E0561
• E0562

This change means more streamlined processes and less administrative burden for you, allowing you to focus more on patient care.

But that's not all! BCBSNE has also decided to reprocess claims received for dates of service beginning Jan. 10, 2025. Any claims previously denied will be automatically reprocessed, so there's no need for you to submit a reconsideration request. This is our way of showing our commitment to making your experience as smooth and hassle-free as possible.

Thank you for your continued partnership and dedication to providing excellent care. We are excited about this change and believe it will make a significant positive impact on your practice.

If the information on an already processed claim is incorrect or charges need to be added or voided, please submit a corrected claim electronically.

Steps to submit a corrected claim electronically

1. Enter claim frequency type code: Place a value of 7 (replacement of prior claim) or 8 (void/cancel of prior claim) in Loop 2300 Segment CLM-Claim Information Field 05-3-Claim Frequency Type Code in the 837 file.
2. Provide original claim number: Enter the original claim number assigned by Blue Cross and Blue Shield of Nebraska (BCBSNE) in Loop 2300 Segment REF*F8 - Payer Claim Control Number Field 02-Reference Identification.
3. Corresponding elements on CMS claim form: These two element/segment values on the electronic claim form correspond to Box 22 on an 837P or Boxes 4 and 64 for an 837I (Claim Frequency Type Code and Claim Original Reference Number/Document Control Number) on the CMS claim form.
4. Type of bill (TOB) 7: Indicates you are replacing a previously submitted claim. Do not change or remove data that needs to process again – submit the complete claim with the changes made.

Voiding and resubmitting claims

1. Voiding incorrect claims: Claims submitted and processed under an incorrect patient and/or member identification (ID) number will need to be voided before a new claim is submitted. Resubmit the claim as it was originally submitted, but with a claim frequency code 8 to void the inaccurate claim record.
2. Submitting a new claim: Submit a new claim with correct patient and/or ID information using claim frequency code 1. Claims with frequency code 1 do not need a claim number submitted in the original reference number field.

Submitting corrected claims with attachments

If you are not able to file your corrected claim electronically because your claim will include attachments, you must file your corrected paper claim to BCBSNE with the attachments.

Do not submit corrected claims using a Reconsideration Request form.

Please refer to GP-X-039 Corrected Claims for more information.

Effective Feb. 1, 2025, dispensing fees will no longer be considered content to the hearing aid purchase and, if billed, will no longer deny as provider contractual write-off.

The Risk Adjustment Department at BCBSNE will be transitioning to a new platform for requesting medical records. This transition will occur over the next several months.

The current fax number where Risk Adjustment Medical Record requests can be returned is 402-548-4664, this line will remain open during the transition time. 

The new Risk Adjustment medical record request letter will include a portal with an individual access code for healthcare provider offices to upload documents as well as an option to fax medical records to our new fax number 402-506-7032.

We appreciate your patience as we transition to this new platform. 

Effective Jan. 1, 2025, BCBSNE no longer accepts paper (faxed or mailed) timely filing override requests. As part of our ongoing transition to paperless processes, all timely filing override requests must be submitted via NaviNet.

Please note that we will no longer process or return paper timely filing override requests received via fax or mail.

The Nebraska Applied Behavior Analyst (ABA) Board has announced that all Behavior Analysts practicing in Nebraska must obtain state licensure within 90 days following Sept. 2, 2024.

BCBSNE will update licensure requirements for this provider type during recredentialing. 

Please be sure to update your professional license information in the personal information section in the CAQH Provider Data Portal.

For those applying for initial credentialing please have your license number before applying. BCBSNE is returning applications if licenses are not included on the application. If you have already submitted your application, please reapply when you receive your license. Previous board certification will still be required. 

Behavior Analysts who are due for recredentialing, without a license on file, participation will be terminated until a new application with license and previous board certification will be needed.

Our Medicare pricing tool utilizes the NPPES data registry to link the Medicare Number/CCN with the NPI data listed in the registry. If there is a discrepancy between the data in the registry and what is submitted on the claim, the claims may be delayed or potentially returned. Therefore, it is crucial for providers to ensure accurate updates to the NPPES and to deactivate outdated information.

Nearly a year ago, as a result of the Change Healthcare cyberattack that suspended claims processing services for many providers, BCBSNE extended financial assistance, facilitated transitions to new clearinghouses and allowed timely filing extensions when appropriate. Please note that as of Oct. 24, 2024, we have returned to adhering to contractual timely filing limits for all providers.