Clinical Research Study

If a member with Blue Cross and Blue Shield of Nebraska (BCBSNE) Medicare Advantage coverage participates in a Medicare-qualified clinical research study, Original Medicare will pay the provider on behalf of the BCBSNE plan. BCBSNE will pay for Medicare-covered services that are not affiliated with the clinical trial. Therefore, providers must submit claims for Medicare-covered services related to the clinical trial to carriers and fiscal intermediaries, not to BCBSNE, using the proper modifiers and diagnoses codes. Medicare-covered services not affiliated with clinical trials must be billed to BCBSNE, and BCBSNE will reimburse providers accordingly.