Medicare Advantage

BCBSNE is implementing changes to MA reimbursement for select non-PHO provider types effective Jan. 1, 2027.

Affected provider types include:

• Radiology
• Laboratory
• Skilled Nursing Facilities (SNF)

Please review the details of these reimbursement changes by visiting NaviNet.

Registration is now open for providers who wish to continue receiving electronic payments for MA claims when payment processing transitions to the Zelis ePayment Center on Jan. 1, 2027.

Providers who do not complete enrollment by Dec. 30, 2026, will receive paper claim payments and paper remittance information.

Visit NaviNet for registration instructions and additional details.

Beginning Jan. 1, 2027, MA providers will begin using the P3 Availity Provider Portal for 2027 MA business, including claim status inquiries, provider resources, education materials and future MA enhancements.

It is important to remember that 2026 and 2027 MA business will be managed in different systems during the transition period:

• 2026 MA information and claims with 2026 dates of service will continue to be accessed and managed through NaviNet.
  
• 2027 MA information and claims with dates of service on or after Jan. 1, 2027, will be accessed and managed through the P3 Availity Provider Portal.

As part of this next phase of the BCBSNE and P3 Health Partners partnership, P3 Health Partners will assume responsibility for processing MA claims with 2027 dates of service.

Additional changes for 2027 MA business include:

• New claim submission requirements and payer IDs for MA claims with 2027 dates of service.
• Claim status inquiries through the P3 Availity Provider Portal.
• Updates to remittance and payment processes, including separate MA and Commercial 835 remittance files.
• New claim appeals, correspondence and provider inquiry workflows.

Additional information about the MA transition will be shared in the special MA edition of the Provider Newsletter on Oct. 15, 2026. Training opportunities and implementation resources will also be communicated as we prepare for the Jan. 1, 2027, go-live date.

Key takeaway: Continue using NaviNet for 2026 MA information and claims, and prepare to use the P3 Availity Provider Portal for 2027 MA information and claims beginning Jan. 1, 2027.

No action is required at this time. We will continue to provide updates and resources to help providers prepare for the transition.

Effective Jan. 1, 2027, BCBSNE MA member ID cards will have a new look.

What Providers Need to Know

• All MA members will receive a new member ID card for 2027.
• Existing MA members who had coverage in 2026 will keep the same member ID number for 2027.
• QR codes will no longer appear on MA member ID cards.
• The applicable payer ID, A6492, for MA claims with dates of service Jan. 1, 2027, and after will be displayed on the member ID card to help providers identify the correct payer ID when submitting claims.
• The member ID card will also include the claims submission address for 2027 MA claims.
  
  PO Box 5015
  Scranton, PA 18505

Example of New Member ID Card

Provider Action

Please review member ID cards presented at the time of service and use the member ID number and payer ID shown on the card when submitting claims, checking eligibility or benefits, requesting prior authorization and conducting other member-specific transactions.

This update is especially important as MA claims with 2027 dates of service will be submitted using a separate payer ID from Commercial and Dental claims. The payer ID displayed on the member ID card can help ensure claims are submitted correctly and help avoid processing delays.

Effective Jan. 1, 2027, Blue Cross and Blue Shield of Nebraska (BCBSNE) will implement federal interoperability and prior authorization transparency requirements under the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F). BCBSNE will publish annual prior authorization metrics, maintain information regarding services requiring prior authorization and make available educational resources related to health information exchange initiatives. For more information, visit the CMS Interoperability and Prior Authorization Final Rule webpage. 

At this time, no action is required from providers. Additional details will be shared in upcoming provider communications prior to the Jan. 1, 2027, effective date.

Providers should use MedPolicy Blue to access MA medical and pharmacy policies, including services and procedures that require prior authorization.

With MedPolicy Blue, you can:

• Search for specific policies and authorization requirements by code.
• View services and procedures requiring prior authorization.
• Filter results by category, including MA Medical Policies & Pharmacy Policies, to quickly locate MA-specific guidance.

Provider Tip: If no policy is returned when searching a specific code in MedPolicy Blue, prior authorization is generally not required for that service. Claims will not deny solely for lack of prior authorization when no authorization requirement exists. Standard claim adjudication and benefit requirements still apply.

Blue Cross and Blue Shield of Nebraska is standardizing payer ID usage and claim acknowledgement processes to simplify electronic claims submission and improve consistency across Commercial, Dental and Medicare Advantage lines of business. Providers should continue working with their practice management system vendor or clearinghouse to ensure payer ID configurations are updated for the appropriate payer ID: 77780 for Commercial and Dental, A6492 for Medicare Advantage (as of Jan. 1, 2027).

Beginning Jan. 1, 2027, BCBSNE will also retire the Claim Confirmation Report and move to the standard ASC X12 277CA claim acknowledgement transaction for all trading partners. Additional details, including payer ID guidance, timing and readiness steps, are available in the August provider newsletter found in the Alerts & Updates for Providers page.

BCBSNE is continuing to strengthen our Medicare Advantage (MA) operations in partnership with P3 Health. These planned enhancements are designed to improve care coordination, streamline processes, and enhance provider support—while maintaining continuity for members and minimizing provider disruption. Below is a high‑level overview of what’s changing and when. Additional details and resources will be shared on NebraskaBlue – Happening Now as effective dates approach.

Key Upcoming Changes

Effective May 1, 2026

• Prior Authorization Submission
  
  • New MA prior authorizations will be submitted through P3 Provider Portal, accessed via NaviNet.
  • Providers will also use P3 Provider Portal to check the status of new authorization requests.
  • Preauthorization phone and fax numbers will remain the same. 
• Care Management, Risk & Quality Programs
  
  • Care management, risk and quality activities for MA will transition to P3 Health.

Effective June 1, 2026

• Medical Necessity Criteria
  
  • MA utilization management criteria will transition from InterQual to MCG (Milliman Care Guidelines).
  • MCG guidelines will be available to providers in NaviNet prior to implementation to support transparency and CMS requirements.

Additional updates may appear across NebraskaBlue online resources as certain MA processes transition to P3 Health. This includes management of MA policies and procedures, management of part B drug prior authorizations and preauthorization services previously supported by Evolent for MSK and IPM. These transitions are operational in nature, and we will continue to communicate details, timelines and any provider impact as more information becomes available.

These enhancements will be implemented in phases throughout 2026. Providers are encouraged to regularly visit NebraskaBlue – Happening Now for the latest updates as effective dates approach.

We updated our Medicare Advantage chiropractic care policy to clarify routine service requirements. Medicare covers spinal manipulation when medically necessary and billed with the correct CPT code and the AT modifier, which should not be used for routine care.

Routine services are not covered by Original Medicare, but BCBSNE Medicare Advantage plans include enhanced routine coverage. Members have a $20 copay per routine visit and receive one set of diagnostic x‑rays per year at no cost when completed by a chiropractor.

For full details, review Policy MA‑X‑082.