Claim Support
We use Electronic Data Exchange (EDI) to streamline and expedite the claim submission process. To learn how to submit claims through EDI and track their progress in NaviNet®, please refer to the information below.
Answers to our most frequently asked questions are found in our Provider FAQ.
For additional guidance, see the eLearning videos and Provider FAQs in our Provider Academy.
Claim Support
The preferred way to submit claims is through the Electronic Data Interchange (EDI). Claims can be submitted through your preferred clearinghouse as long as you are a BCBSNE-credentialed provider. If you do not already have a clearinghouse, BCBSNE offers free billing software and support to help you submit claims electronically.
Learn more about the Electronic Data Interchange and PC-ACE Software »
To adjust or replace a claim, please review the Replacement Claims in Section 8 of the General BCBSNE Provider Procedures Manual.
To adjust or replace a claim, please review the Claims Adjustment Reason Codes and Remittance Advice Remark Codes.
You can also use PC-ACE, a free electronic claims processing software. The claims review software uses nationally accepted and sourced guidelines, including Current Procedural Terminology (CPT) regulations as documented by the American Medical Association (AMA), Correct Coding Initiatives (CCI) and Post-Operative Period Guidelines as outlined by the Centers for Medicare and Medicaid Services (CMS).
More about PC-ACE and Remittance »
Note: Corrected or replacement claims must be filed electronically. Corrected claims submitted on paper by a provider with electronic claim filing capabilities will be returned with instructions to submit the corrected claim electronically. If your corrected claim includes attachments, your corrected paper claim must be filed to Blue Cross and Blue Shield of Nebraska, attached to a Reconsideration Request Form, as you have done in the past. If you have any questions regarding how to submit a replacement claim electronically, please refer to the HIPAA ANSI X12N 837P or HIPAA ANSI X12N837I implementation guide for detailed instructions.
Additional resources:
- Medically Unlikely Edits (MUE) – Includes frequently asked questions on MUEs, along with updated MUE information.
CMS.gov
- National Correct Coding Initiative (NCCI) Edits – Provides guidance on the NCCI policy manual for Medicare Services as well as FAQs for NCCI edits for Iowa, Kansas, Missouri and Nebraska providers.
wpsgha.com
Self Service
Note: To check claim status in NaviNet, you'll first need to register for a NaviNet account. The resources below will guide you through the registration process.
Who can access NaviNet?
Participating health care and dental providers, and non-participating health care providers within the state of Nebraska who have their information on file with BCBSNE can enroll for access.
Is there a cost to access NaviNet?
No. BCBSNE offers the NaviNet features and functionality at no charge.
How do I register with NaviNet?
Each office must have a minimum of one Security Officer who is responsible for registering with NaviNet, adding users to the account, and granting user access. Your designated security officer should go to https://register.navinet.net/ to begin the registration process.
- Registration takes between 5-7 business days.
- Registration requires a Tax ID and email address.
- Each user will have their own username and password. No sharing is allowed.
- Users have 60 days to log in for the first time before they will become disabled.
- Users should see their Security Officer to have their password reset if they become disabled.
- Provider Registration Flyer
I am already registered with NaviNet. Do I have access to BCBSNE information?
If you are an existing NaviNet user, and are either a participating BCBSNE network provider, or are a healthcare provider within the state of Nebraska, you should see Blue Cross Blue Shield of Nebraska as an option in your Health Plans List. If you are a non-participating provider, your office must be loaded on the BCBSNE provider file.
Our office outsources our billing and payment to a third-party billing service. Can a billing service register with NaviNet?
Yes, but for security, the registration process will include validation and authentication with the provider office before access is permitted.
Who should I contact if I experience any difficulties using NaviNet?
To report a technical problem, call 888-482-8057 – available Monday - Friday, 7:00 a.m. – 10:00 p.m. CT, Saturday, 7:00 a.m. – 2:00 p.m. CT.
Quickly check the status of a claim through NaviNet.
In response to your feedback, we are happy to provide enhancements to improve your service experience and provide efficient resolution of claim questions and inquiries.
Claims Investigation » Help Guide
The new Claims Investigation tool is now available by logging into NaviNet.
FEP Dental Schedule
Dental Code |
Dental Service |
FEP Standard Option
|
MAC
|
|
| Up to Age 13 | Age 13 and Over | |||
| D0120 | Periodic oral evaluation |
$12 | $8 | $51 |
| D0140 | Limited oral evaluation - problem focused |
$14 | $9 | $76 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
$14 |
$9 |
$84 |
| D0160 Standard Option only |
Detailed and extensive oral evaluation - problem focused, by report |
$14 |
$9 |
$137 |
| D0210 |
Intraoral - complete series of radiographic images |
$36 |
$22 |
$131 |
| D1110 |
Prophylaxis - adult |
N/A |
$16 |
$90 |
| D1120 |
Prophylaxis - child |
$22 | $14 | $66 |
| D1206 | Topical application of fluoride varnish | $13 | $8 | $38 |
| D1208 | Topical application of fluoride - excluding varnish | $13 | $8 | $36 |
| D1351 Basic Option only |
Sealant - per tooth | N/A | N/A | $54 |
| D1352 Basic Option only |
Preventive resin restoration in a moderate to high caries risk patient - permanent tooth | N/A | N/A | $100 |
| D2940 Standard Option only |
Protective Restoration | $24 | $15 | $115 |
| D9110 Standard Option only |
Palliative (emergency) treatment of dental pain - minor procedure | $24 | $15 | $127 |
Dental Code |
Dental Service |
FEP Standard Option
|
MAC
|
|
| Up to Age 13 | Age 13 and Over | |||
| D0120 | Periodic oral evaluation |
$12 | $8 | $49 |
| D0140 | Limited oral evaluation - problem focused |
$14 | $9 | $72 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
$14 |
$9 |
$79 |
| D0160 Standard Option only |
Detailed and extensive oral evaluation - problem focused, by report |
$14 |
$9 |
$132 |
| D0210 |
Intraoral - complete series of radiographic images |
$36 |
$22 |
$126 |
| D1110 |
Prophylaxis - adult |
N/A |
$16 |
$87 |
| D1120 |
Prophylaxis - child |
$22 | $14 | $63 |
| D1206 | Topical application of fluoride varnish | $13 | $8 | $37 |
| D1208 | Topical application of fluoride - excluding varnish | $13 | $8 | $35 |
| D1351 Basic Option only |
Sealant - per tooth | N/A | N/A | $51 |
| D1352 Basic Option only |
Preventive resin restoration in a moderate to high caries risk patient - permanent tooth | N/A | N/A | $93 |
| D2940 Standard Option only |
Protective Restoration | $24 | $15 | $108 |
| D9110 Standard Option only |
Palliative (emergency) treatment of dental pain - minor procedure | $24 | $15 | $118 |
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