Care Management

The Blue Cross and Blue Shield of Nebraska (BCBSNE) Care Management program promotes cost-effective and medically appropriate care and services. Components include clinical review of selected services, care transition and case management. 

This comprehensive approach employs key interactive medical management activities across the care continuum so that BCBSNE can achieve its goal for Medicare Advantage members. 

Care Management Services 

Care Management provides the following services: 

• Clinical review of inpatient and select Part B medications.
• Provider appeal process. 
• Analysis of utilization data for trends in over and underutilization. 
• Inter-rater reliability testing. 
• 24/7 On-Call nurse availability for urgent after-hour requests. 
• Coordination of care after a member is discharged from an inpatient acute care facility. 
• Identification of members for case manager program referrals. 
• Quality Management Program Development.

Contacting Care Management (Normal Business Hours) 
Providers can contact Care Management representatives as specified below. 

Utilization Management 
Normal business hours:

8:00 a.m. to 4:30 p.m. CST Monday through Thursday  
8:30 a.m. to 4:30 p.m. CST Friday 

The department is closed for lunch for phone calls only from 11:00 a.m. - 12:00 p.m. CST daily. 

Toll-free telephone for service requests (Inbound call center available for providers for servicing requests that require authorization) 877-399-1671. 

Providers may also submit requests for authorization via Fax 24/7. Note: Faxed requests will only be processed during normal business hours: 

866-422-5120 All authorization requests except Part B and Radiology 
855-342-9648 Part B Medications 

Care Transition and Case Management 
Telephonic Nurses will provide outreach to members. 

Case Managers (CM) and Care Transition (CT) nurses are available during normal business hours: 

8:00 a.m. to 4:30 p.m. CST Monday through Thursday 
8:30 a.m. to 4:30 p.m. CST Friday  
Phone: 877-399-1675 (CM,CT)  
Fax: 866-588-9145 (CM) 

Contacting Care Management (After Hours) 
An after-hours program is available Monday-Friday to respond to urgent utilization management related issues after normal business hours on weekdays and 24 hours/day on weekends and holidays. 

Care managers available after normal business hours and on weekends and holidays, with 24-hour service to assist physicians and other providers. 

Providers should call 877-399-1674 and follow the prompts to reach a care manager for any of the following needs: 

• Determining alternatives to inpatient admissions and triaging members to alternate care settings. 
• Arranging for emergent home health care, home infusion services and in-home pain control. 
• Arranging for durable medical equipment. 
• Coordinating and obtaining authorization for emergent discharge plans. 
• Expedited appeals of utilization management decisions. 

Note: Precertification for admission to skilled nursing facilities and other types of transitional care services should be called in during normal business hours unless there are extenuating circumstances that require emergent placement.