Contiguous Area Claim Filing

A contiguous area is generally defined as a county bordering another Blue Plan’s service area. For example, Council Bluffs, Iowa in Pottawattamie County is in Wellmark Blue Cross and Blue Shield’s service area. Pottawattamie County is contiguous with the border of Blue Cross and Blue Shield of Nebraska’s (BCBSNE) service area. Contiguous area guidelines do not apply to Federal Employee Program (FEP) claims; FEP claims should be filed to the state the provider is located with the only exception of Medicare Crossover claims.  

If you are in a non-Nebraska county that is contiguous with BCBSNE’s service area AND have a PPO contract with both plans, file claims for BCBSNE patients with the Blue Plan in the state in which the member lives or works. Claims filing rules for contiguous area providers are based on the permitted terms of the provider contract  

• Provider location (i.e., in which Plan service area is the provider’s office located)  
• Provider contract with the two contiguous counties (i.e., does the provider have a PPO contract with only one or both service areas?)  
• The member’s Home Plan and where the member lives (i.e., is the member’s Home Plan within one of the contiguous county’s Plans?)  
• The location of where the services were received (i.e., does the member work and reside in one contiguous county and see a provider in another contiguous county?)

NOTE: Contiguous counties guidelines only apply to a PPO product and do not apply to ancillary claim filing. Contiguous county guidelines do not apply to the FEP product.