Application for Reinstatement following Network Termination or Non-Payable Status

Providers may reapply for reinstatement in instances where Blue Cross and Blue Shield of Nebraska (BCBSNE) terminated their plan network participation or placed them in a non-payable status.  

Network Termination Reinstatement  

Providers who have been terminated from participation with plan networks can reapply for participation 12 months following the termination effective date. The provider must meet all credentialing requirements, provide evidence that the deficiency(ies) that resulted in plan network termination have been remedied and submit a Reinstatement Plan detailing how compliance with BCBSNE policies will be maintained. BCBSNE will review the submitted Reinstatement Plan to ensure the provider adequately addressed all deficiency(ies). BCBSNE will amend the Reinstatement Plan if adjustments are deemed necessary. The provider can accept the terms outlined in the amended Reinstatement Plan or remain terminated from participation with plan networks.

Payable Status Reinstatement  

Providers who have had their status changed to non-payable can request a review of the non-payable status 36 months following the status change effective date. The provider must meet all credentialing requirements, provide evidence that the deficiency(ies) that resulted in the payment status change have been remedied and submit a Reinstatement Plan detailing how compliance with BCBSNE policies will be maintained. BCBSNE will review the submitted Reinstatement Plan to ensure the provider adequately addressed all deficiency(ies). BCBSNE will amend the Reinstatement Plan if adjustments are deemed necessary. The provider can accept the terms outlined in the amended Reinstatement Plan or remain in a non-payable status with BCBSNE.  

Note: As a condition of reinstatement, BCBSNE reserves the right to require that a provider contract with an independent, third-party entity approved by BCBSNE to monitor for compliance with BCBSNE policies. The provider bears the full financial responsibility of contracting with the auditing entity. The auditing entity and BCBSNE may monitor for compliance with the Reinstatement Plan by conducting on-site office or facility visits, medical record reviews or any other actions deemed appropriate by BCBSNE. The provider may also be held financially responsible by BCBSNE for costs associated with increased claim, medical record and preauthorization review time necessary to ensure compliance with the Reinstatement Plan. The review period and expected costs will be added to the Reinstatement Plan if deemed necessary by BCBSNE.