Administrative Updates

Please note: This form is for use by PHMHP, PLADC, PLCSW, PPhD, PPsyD and RBT Nebraska providers only. Requested effective dates cannot be prior to the date the form is submitted. If no effective date is given or an effective date is requested prior to the date the form is submitted, the assigned effective date will be the date the form was submitted.

The Provisional Provider form is used to add a new provisionally-licensed behavioral health provider and report their supervising practitioner's information. This form can also be used to update the supervising practitioner's information for an existing provisional provider. 

To avoid claim impacts, please do not submit claims for the Provisional Provider until you have received notification the request has been completed. Claims submitted prior to the Provisional Provider being loaded may be processed as out of network or delayed. 

Please allow up to 60 days for completion of this process. 

Email the form to HealthNetworkRequests@NebraskaBlue.com

You will receive an email confirmation when your request is received. The email will indicate how long to allow for changes and how to inquire about their status. You will also be notified via email when your request has been completed.

Please note: This agreement is not required for providers using a clearinghouse.

The Trading Partner Agreement is a HIPAA-required business associate agreement between BCBSNE and its trading partners. This agreement is a legally binding contract.

Email the form to ProviderServicesOperationsSupport@NebraskaBlue.com

You will receive an email confirmation when your request is received. The email will indicate how long to allow for changes and how to inquire about their status. You will also be notified via email when your request has been completed.

Important Information
Once the group has become delegated and notice has been sent via email with effective date, the process to submit changes is below:

• Updates must be sent from the approved contact on file via spreadsheet template (please request the template as this can change)
• Delegation updates must be sent via email to delegatednotices@nebraskablue.com; updates are worked in received date order
• Claim submissions should not begin until you receive notification the submission is complete
  • Normally upload is 60 days after submission 
  • Timeline can change – current backlog timeline can be found on NaviNet Plan Central
• Claims submitted prior to receiving notification will be returned
  • Claims cannot process until the information is loaded 
  • If it is preferred to have claims process out of network, claims will need to be dropped to paper and submitted with providers SSN or non-contracted TIN
  • Claims submitted prior to timeline listed on NaviNet will be the responsibility of the provider to resubmit 

Additional Details

• Delegations are required to submit credentialing profiles within 30 calendar days of their committee approval date
• Terminations must be submitted within 5 business days
• Responses to inquiries for information must be submitted within 14 calendar days
  

Please note: Requests must include a voided check and/or bank letter to complete the validation process.

EFT information can be added or updated by completing the Electronic Funds Transfer Enrollment Request form.

To cancel your EFT enrollment, please send an email to HealthNetworkRequests@NebraskaBlue.com

Please allow up to 10 business days for completion of this process.

Email the form to HealthNetworkRequests@NebraskaBlue.com

You will receive an email confirmation when your request is received. The email will indicate how long to allow for changes and how to inquire about their status. You will also be notified via email when your request has been completed.

Learn more about Electronic Funds Transfer

The Electronic Remittance Advice Enrollment form is used to enable electronic remittance advice (835). You may also use the form to update your ERA information on file.

Please allow up to 10 business days for completion of this process. 

Email the form to HealthNetworkRequests@NebraskaBlue.com

You will receive an email confirmation when your request is received. The email will indicate how long to allow for changes and how to inquire about their status. You will also be notified via email when your request has been completed.

Please note: Registration is not required for providers using a clearinghouse.

The Trading Partner Registration form is required to conduct electronic business transactions directly with BCBSNE.   

Please allow up to 10 business days for completion of this process. 

Email the form to ProviderServicesOperationsSupport@NebraskaBlue.com

You will receive an email confirmation when your request is received. The email will indicate how long to allow for changes and how to inquire about their status. You will also be notified via email when your request has been completed.

Please note: This form is to be used only for a clinic/Tax ID level address change. This form is not for provider level updates. All provider demographic changes should be submitted in CAQH.

• Change of Address Form

To terminate a location you currently practice at, please archive the location within your CAQH profile. This update will be made within 48-hours from submission.
 
To terminate a provider (all locations) or a Tax ID, please send an email to HealthNetworkRequests@NebraskaBlue.com with the following information:

• Provider name of the provider and/or practice terminating
• Provider NPI
• Tax ID
• Address
• Termination date (month/day/year)
• The group your contract should be transferred to and which group (if applicable) 

For termination requests without a transfer notice to another group, BCBSNE will process the termination and send a letter to all members that have seen the provider in the last 18 months. This applies when the provider is no longer active under an existing agreement at any location.

For termination requests with a transfer notice to another group, BCBSNE will sync with both parties and process the transfer accordingly. A notification is not sent to members. This applies when the provider will remain active under an existing agreement at any location.

If claims were received after the requested termination date, you will be contacted to validate the termination date. We may request corrected claims are submitted. For additional information on submitting corrected claims, please refer to the Corrected Claims policy.

Please allow up to 15 days for completion of this process. After the termination is processed, please allow up to 24 hours for updates to be displayed in the Provider Finder.