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Medicare Advantage Provider Update
January 2025
Welcome to our new special edition Medicare Advantage (MA) Update Newsletter. The operations of Blue Cross and Blue Shield of Nebraska (BCBSNE) MA program is fully in house effective Jan. 1, 2025. With this transition we have created a separate MA only Provider Update Newsletter for January and March of 2025.
New ID number for current BCBSNE Medicare Advantage members effective Jan. 1, 2025
Key Points to Remember:
- New ID cards: Members began to receive new ID cards in the mail beginning November 2024.
- Prefix for new ID cards: To help identify which ID card is the new one for Jan. 1, 2025, the prefix will be different.
- YMA4 will be the new prefix for the HMO product instead of YMAN.
- Y2M4 will be the new prefix for the PPO product instead of Y2MN.
- NaviNet®: Please be advised NaviNet may display the new ID number as active prior to Jan. 1, 2025. However:
- Effective date: These new ID numbers will not be valid until Jan. 1, 2025.
- Usage: Please note that the new ID numbers should be used for services on or after Jan. 1, 2025.
If you receive a new ID number from a current BCBSNE MA member, please remember that it will only be effective for dates of service from Jan. 1, 2025, onwards.
Thank you for your attention to this important update!
MA Provider Procedure updates
Since we brought the operations of our MA program fully in house on Jan. 1, 2025, we have some exciting updates on our Nebraska Blue Medicare Advantage page.
Starting in January 2025, you will be able to use the BCBSNE Provider Procedures search tool to locate MA procedures. When searching for a MA procedure with a keyword in this tool, you can filter the policies by selecting the MA tag on the left-hand side of the search results.
For more information on the BCBSNE Provider Procedures, you can review the eLearning on the Provider Academy.
New MA only eLearnings and webinars will also be available on the Provider Academy.
The MA Happening Now page will be housed on the NebraskaBlue Medicare Advantage page. This will be your one stop shop for all things MA.
MA provider customer service for 2025
For claim information, providers should continue following the current process by calling 1-888-505-2022 and select the correct option for 2024 or 2025 information.
If you have 2025 claim, benefits and/or eligibility questions you can access this information at any time on NaviNet.
Medicare Advantage Split-Year Claim Submission
MA Outpatient, Professional Claims and CAH Swing Bed
For MA 2024-2025 outpatient, professional and CAH swing bed claims with charges incurred during different years, the charges must be submitted on separate claims.
For example:
If dates of service are from Dec. 15, 2024, to Jan. 15, 2025:
- Submit charges incurred from Dec. 15, 2024, to Dec. 31, 2024, on one claim
- Submit charges incurred from Jan. 1, 2025, to Jan. 15, 2025, on a separate claim
Claims submitted with charges incurred during both years on the same claim will be rejected back to the provider to split the claim.
MA claims update
When submitting MA claims, Centers for Medicare and Medicaid (CMS) standards must be followed to prevent unnecessary returns and processing delays. Effective June 4, 2024, with the CMS edits in place you will see non-Nebraska MA claims process more appropriately.
Beginning Nov. 26, 2024, we began adjusting claims appropriately prior to June 2024, in accordance with the MA adjustment language. Providers can expect to see these adjustments reflected throughout December 2024 and January 2025.
Please do not submit Reconsideration Requests for claims you believe did not pay correctly. We will be running reports to determine if adjustments or recoupments are needed. Reminder: Claim return letters are now available in Plan Documents on NaviNet.
Below are three common CMS standards that would need to be followed to avoid claims being returned or denied.
DME NU and RR modifiers
- Claims that are billing supply codes with NU modifier, and they do not require an NU modifier, will be denied.
- If billed without BP and BR modifiers that go with certain rentals, they will be denied as well.
Federally Qualified Health Centers (FQHC) and Rural Health Claims
- Per CMS guidelines MA FQHC and rural health claims will need to be billed on a UB04 instead of on a CMS 1500 form.
- We were not enforcing before and are now and will be returning or denying claims as appropriate.
Ambulance for MA only
- Per CMS guidelines, ground mileage totaling up to 100 covered miles must be reported to the nearest tenth of a mile. In addition, all air ambulance mileage must be reported as fractional units to the nearest tenth of a mile. When reporting fractional mileage, providers must round the total miles up to the nearest tenth of a mile.
- Professional electronic – When submitting fractional units, the provider needs to submit the same fractional units in the Ambulance Mileage field on the 837P AND the units field.
- Professional paper (CMS-1500) – When submitting fractional units, the provider needs to submit the fractional units in the units field.
- Institutional electronic – When submitting fractional units, the provider needs to submit the fractional unit in the units field. There is not a separate Ambulance Mileage field on the 837I for Institutional.
- Institutional paper (UB-04) – Providers should continue to submit whole units as decimals are not allowed on the UB in the units field.
- Claims will be returned if not submitted correctly.
Annual Wellness Visits and Comprehensive Physical Exams
It is time to start planning for 2025 Annual Wellness Visits (AWV) and Comprehensive Physical Exams (CPE). Preventive and wellness care has multiple benefits for your practice and your patients. When implemented effectively, AWV/CPEs can benefit your practice by:
- Creating an opportunity to build a complete medical history for your entire patient panel
- Strengthen your relationship and communication with your patients
- Increase patient engagement
- Increase quality metrics and close care gaps
BCBSNE covers the cost of your patient’s AWV and CPE once per calendar year. Please note: If additional tests and procedures (labs, EKG) are ordered or completed during the same visit, copays and deductibles may apply).
Now is the time to start planning and scheduling your patient’s AWV/CPE visits.
BCBSNE is committed to helping our providers in building strong relationships with our members. If you are interested in assistance in building an efficient and effective AWV/CPE workflow within your clinic, please reach out to Erin Kuhr for more information.
2025 MA prescription benefits
We are delighted to offer our MA members the ability to fill prescriptions for 100 days in 2025.
Filling maintenance medications for 100 days at a time is not only convenient but also helps patients stay adherent to their treatment plans and take their medications as prescribed by their health care provider.
Why is health literacy important?
Studies have shown health literacy has a multi-billion-dollar impact on Americans and is directly tied to their physical health. Researchers have found an association between limited health literacy and an increase in preventable hospital visits and admissions, misunderstanding instructions about prescription medications and a negative association with preventive services, management of chronic conditions and self-reported health.
Some groups are more likely than others to have limited health literacy. They include but are not limited to: adults over the age of 65, minorities, non-English speaking individuals, people with less than a high school degree or GED and people with incomes at or below the poverty level.
One of the most interesting suggestions to improve health literacy is to employ a “universal precautions” approach. It can be impossible to determine who is affected when 9 out of 10 English-speaking adults have less than proficient health literacy skills. So, just as it is common practice to follow universal precautions like wearing gloves when there is a risk of exposure to blood or bodily fluids, it makes sense to provide the same approach when having conversations with patients. Studies found that even people with a high health literacy appreciated the additional communication.
MA CAHPS and HOS survey results
Every year, BCBSNE administers, in partnership with a third-party vendor, the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey and the Health Outcomes Survey (HOS) to a subset of our MA members. The results not only provide important insight into our members’ perception of their health care experience but are reported to the CMS for inclusion in calculating the plan’s Medicare Star rating.
Both surveys are “blind” meaning we do not know which members receive the request to complete it. Our vendor receives our enrollment directly from CMS and randomly picks a predetermined number of members to receive the survey. The vendor sends the surveys and then tabulates and sends the results directly to CMS.
We are pleased to share the provider-related CAHPS results with you for the survey that took place in the Spring. Results are rated on a 1 to 5 scale, with five Stars being the highest.
| HMO Plan | PPO Plan |
|
| Getting Needed Care |
5 Stars |
5 Stars |
| Getting Care Quickly |
5 Stars |
5 Stars |
| Rating of Health Care |
4 Stars |
5 Stars |
| Coordination of Care |
4 Stars | 4 Stars |
| Flu |
3 Stars |
4 Stars |
The HOS Survey is used to assess the physical and mental health outcomes of our members.
The results of the most recent survey are as follows.
| HMO Plan | PPO Plan |
|
| Monitoring Physical Activity | 2 Stars | 2 Stars |
| Fall Risk Management | n/a* |
1 Stars |
| Improving Bladder Control | n/a* |
3 Stars |
*Due to the small number of responses, a Star rating was not issued for these measures
We are excited to announce we will be sharing more information with our providers in 2025 on how CAHPS and HOS surveys can impact the patient experience and health outcomes!
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