Happening Now

We have noticed an increase in faxes requesting the status of preauthorization reviews. This is unnecessary and is impacting the efficiency of our fax system. To streamline the process, please follow the steps below to check the status of your preauthorization requests.

Checking Status via NaviNet^®
To check the status of a preauthorization request submitted via NaviNet, please follow these steps:

1. Log in to NaviNet.
2. Under Workflows for this Plan, select Preauthorization or Precertification.
3. Select the ordering provider and click the submit button.

Note: The rendering facility will be able to view the status only if the ordering provider identified the rendering facility when entering the request in NaviNet.

1. Click the Authorization List icon from the menu on the left side of the screen to view the authorizations.

For Preauthorization Requirements
Reminder: To verify if preauthorization is required for a specific procedure code you must utilize the medical policy tool.

Out of Area Members
For out of area members, please select Pre-Service Review for Out of Area Members Workflows.

Additional Help
If your preauthorization request was initially faxed in, you may contact Customer Service at 800-635-0579, Option 5.

For further assistance, please visit our Provider Academy. An eLearning tutorial is available in NaviNet Tips and Tricks.

By following these steps, you can efficiently check the status of your preauthorization requests, reduce the number of unnecessary faxes, and verify Medical Policies. Thank you for your cooperation!

TriWest is experiencing an ongoing issue affecting remittances and is currently at the highest level of escalation.

There is no estimated time for resolution at this moment. Continue to check back here for updates. 

Important Updates:

• April 1, 2025: The TRICARE West Region Referral Waiver has been extended through April 30, 2025.
• April 1, 2025: Behavioral health counselor claims were denied due to a supervisory requirement error. TriWest has corrected this issue and is working to reprocess the claims.

Providers should use the following TriWest resources:

• TRICARE West Region Referral Waiver Approval Letter 4-2-25
• TriWest Provider Resources document 2-21-25
• Talk to a Customer Service Representative at 1-888-TRIWEST (874-9378)
• Click here for help navigating their Provider IVR
• Fax: 866-852-1893 (for same-day, urgent referrals, fax detailed information)

BCBSNE can assist with the following:

• Adding Individual Providers to the TRICARE Roster: Submit through the BCBSNE credentialing process on the credentialing page above
• Adding New group Individual Providers to the TRICARE Roster: Submit through the BCBSNE credentialing process on the credentialing page above
• Adding Existing group Individual Providers to the TRICARE Roster: Submit changes through CAQH Provider Data Portal to have the provider’s information updated

Credentialing Variances for TRICARE Network in Nebraska:

• Licensure Disciplinary Actions: Providers with actions on their state licenses cannot be offered participation in the TRICARE network
• Board Certification: PAs, CRNAs, and CNMs must be board certified to be offered participation in the TRICARE network
• Provisional providers-excluded from TRICARE network.

Accreditation Requirements:

• Birthing Centers: Must be accredited by TJC, AAAJHC, CABC, or AABC and licensed according to state and local laws
• Substance Use Disorder Rehab: Must be accredited by TJC, CARF, or COA
• Intensive Outpatient Programs (IOP): Must be accredited by TJC, CARF, or COA
• Psychiatric Residential Treatment Facilities: Must be accredited by TJC, CARF, or COA
• Residential Treatment Centers (RTC): Must be accredited by TJC, CARF, or COA

Note: These requirements differ from our regular requirements, as we only verify accreditation but do not require it.

From February through May each year, BCBSNE conducts medical record reviews to gather essential Healthcare Effectiveness Data and Information Set (HEDIS) measurement quality data for our members. This process is crucial for assessing the quality of care provided to our patients.

Data Collection Process:

Commercial Members: Data is collected using Reveleer^®.

Medicare Advantage Members: Data is collected through Datavant Health.

Both Reveleer and Datavant Health will reach out to your clinic to request specific clinical details that may not be included in claims data, such as: Blood pressure readings, HbA1c lab results and Colorectal cancer screenings.

Your cooperation in providing these records is vital. It not only helps us meet our quality goals but also enhances the overall health of our members — your patients.

Contractual Obligations:

As a participating provider, your contract includes provisions for supplying requested records to BCBSNE or our third-party vendors at no charge. We aim to minimize disruptions to your office workflow; therefore, prompt responses to these requests will reduce the need for follow-ups.

Thank you for your assistance in this important initiative. Your support is invaluable in helping us successfully complete our HEDIS reporting.

For more information on HEDIS, please visit NCQA.org.

BCBSNE Provider Executives are available to support providers with the following:

• Timely Filing Reviews submitted via NaviNet
• Escalated Claims Inquiries
• Provider Agreement Inquiries
• Provider Data Changes

Effective May 1, 2025, you will be able to submit your inquiries to the Provider Executive team via the new Advanced Provider Inquiries form on NaviNet. This form will collect all the required information needed to address your questions, thereby streamlining the process and reducing the number of communications.

Please note that this new form does not replace the existing Claims Investigation process available on NaviNet. You will still need to submit a Claims Investigation request before contacting the Provider Executive team via the Advanced Provider Inquiries form.

As of May 1, 2025, the ProviderExecs@NebraskaBlue.com email account will be decommissioned, and you will no longer be able to send requests to this email address.

For additional updates, including an eLearning module, please refer to Happening Now as the effective date approaches.

Starting Tues. April 1, 2025, BCBSNE will switch our employee health plan telehealth provider from Amwell to Telescope Health.

Our employees may continue to seek telehealth services through their current physician/provider, or they can receive services through Telescope Health for their telehealth needs.

At Telescope Health, they make patient care seamless through effortless collaboration. With patient consent, their Automatic Patient Record Sharing—powered by athenahealth—securely connects providers across care locations. Integrated with CommonWell and Carequality, health data exchanges, it reduces administrative work and streamlines care transitions.

As the primary care or specialty provider, you can receive access to your patient’s medical information if they complete a telehealth visit with Telescope Health and consent to sharing, ensuring continuity of care without extra steps. 

We believe this change will improve telehealth services for our employees. If you have any questions, please contact us.

Thank you for your support and dedication to providing exceptional care.

BCBSNE continues to further our Blue goes Green efforts with a shift towards electronic remittance advices and payments starting in 2025. Here are the key points:

• No more paper remittance advices or checks: Providers will need to transition to electronic remittance advices (835s) and electronic payments.
• Sign up with a clearinghouse: Providers can receive 835s by signing up with a clearinghouse or accessing them in NaviNet.
• Electronic Funds Transfer (EFT): Providers currently receiving paper checks will need to fill out an EFT form to receive electronic payments.
• Forms available on NaviNet: The necessary forms for signing up with a clearinghouse and enrolling in the ERA service are available under the Administrative Updates/Secure Forms link on NaviNet.
• Exception for dentists: Due to limited self-service options in NaviNet, dentists can continue receiving paper remittance advices if they cannot enroll with a clearinghouse.

Helpful links:

• Submitting Claims Electronically
• NaviNet
• Provider Academy

This transition aims to streamline processes and reduce administrative burden as well as paper usage. Please complete these steps as soon as possible. A final date to complete this transition is coming soon. Watch "Happening Now" for the last day to receive paper remittance advices and checks.

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.

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)
• 78452 - 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.

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.

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 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.

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.