Known Issues

Rejection or denial code
N/A

Impacted provider specialty
N/A

Estimated claims reprocessing

Estimated Claims Reprocessing Completion Date: April 1, 2022

Actual claims completion
N/A

Project number
SWP-15235

Note

Due to the Public Health Emergency (“PHE”), co-pays for Nebraska Medicaid members are suspended while the PHE is active. Healthy Blue Nebraska recently discovered that the claims platform was not correctly configured to suspended Nebraska Medicaid Copays for members.

Providers should be aware that Healthy Blue Nebraska has corrected the copay suspension functionality to work as intended. This functionality was corrected on March 21, 2022. Any new day claims received on March 22, 2022 until the end of the PHE should process without a member co-pay.

While the co-pay suspension functionality has been corrected for any newly transmitted claims, Healthy Blue Nebraska will capture and reprocess impacted claims retrospectively back to January 1, 2021. No additional action is needed from impacted providers for this claims reprocessing effort. The estimated completion date of the claims reprocessing project is April 11, 2022.

Rejection or denial code
N/A

Impacted provider specialty
N/A

Estimated claims reprocessing
N/A

Actual claims completion
N/A

Project number
N/A

Note
Coordination of benefits (COB) allows plans that provide health coverage for a member with Medicare to determine their respective payment responsibilities. Claims submitted to Medicare with Healthy Blue secondary or tertiary coverage should automatically transmit to Healthy Blue after the primary payor adjudicates the claim first through this COB functionality.
Providers should be aware that Healthy Blue Nebraska has corrected the COB functionality to work as intended. This functionality was corrected to accept any new COB transmitted claims the week of June 7, 2021.
While this connectivity error has been corrected for any newly transmitted claims, Healthy Blue was not able to capture COB claims from Jan. 1, 2021 to April 30^th. Providers seeking secondary payment for claims within this date range should submit direct billing to Healthy Blue with the accompanying EOB from the primary payor.

Rejection or denial code
N/A

Impacted provider specialty
Physical Therapy
Occupational Therapy
Speech Therapy

Estimated claims reprocessing
October 1, 2021

Actual claims completion
October 8, 2021

Project number
N/A

Note

Eligible Healthy Blue members 20 years of age and younger have no rehabilitative service visit limit. Eligible Healthy Blue members 21 years of age and older have a combined rehabilitative services visit limit of 60 visits per calendar year.

Providers should be aware that Healthy Blue Nebraska has been developing a reconfiguration of the therapy visit accumulator (logic that counts member visits) to calculate encounters as intended. A claims project has been completed to capture and reprocess impacted claims.

Rejection or denial code
Denial Code: f89

Impacted provider specialty
N/A

Estimated claims reprocessing
Week of 4/26/2021

Actual claims completion
N/A

Project number
9555

Note
The Vaccine for Children Program (VFC) provides federally purchased vaccine for most childhood immunizations for Medicaid-eligible children and adolescents.
Providers should be aware that Healthy Blue Nebraska has identified that claims with VFC codes have been denying with denial code: f89. The impacted VFC codes have been reloaded as of April 6th, 2021. Any clean claim line with VFC codes, when billed after April 6th, should process in the Healthy Blue system. Healthy Blue is capturing impacted claims that denied VFC payment from January 1, 2021 through April 6th, 2021 for claims reprocessing and payment when applicable. No action is currently needed from providers related to claims that have VFC denials prior to April 6th, 2021.

Rejection or denial code
N/A

Impacted provider specialty
N/A

Estimated claims reprocessing
N/A

Actual claims completion
N/A

Project number
N/A

Note
The Healthy Blue Member Enrollment Team discovered an issue with the ITS number on subscriber cards issued after 4/21 for the Healthy Blue Nebraska market. These cards do not have all the information on them, and hence need to be reissued. The Healthy Blue Nebraska market has 4,103 members impacted. New subscriber cards were issued on 5/10/2021 directly to the subscribers impacted.

Rejection or denial code
Rejection

Impacted provider specialty
N/A

Estimated claims reprocessing
N/A

Actual claims completion
N/A

Project number
N/A

Note
Healthy Blue EDI and Secure Provider Portal teams identified that a market prefix [FGM] is required on claims preceding the Member Medicaid ID or Healthy Blue Member ID.  Without the addition for the market prefix [FGM], claims may reject.

Healthy Blue EDI and Secure Provider Portal teams are resolving the need for the market prefix [FGM] for the Member Medicaid ID, but will always be required for the Healthy Blue Member ID.

The Project team is updating training and provider materials for updates.

Rejection or denial code
N/A

Impacted provider specialty
N/A

Estimated claims reprocessing
N/A

Actual claims completion
N/A

Project number
N/A

Note
Healthy Blue Nebraska does have a process for providers to confirm eligibility, request authorization and ultimately bill claims for Unborn members. Some key points to confirm eligibility are as follows:

• The Date of Birth will always be a default date of 1/1/2000
• Gender will always be “U” for Unborn
• First Name will always be “Unborn”
• Last Name will always match the mother’s Last Name
• All of the above bulleted elements will be on the member’s card.

Rejection or denial code
N/A

Impacted provider specialty
N/A

Estimated claims reprocessing
N/A

Actual claims completion
N/A

Project number
N/A

Note
Healthy Blue Nebraska providers should be aware that the absence of the Billing Group Taxonomy Number will not result in an automatic rejection when submitting claims to Healthy Blue Nebraska. While Healthy Blue no longer will reject claims based solely on  the absence of a provider’s Billing Group Taxonomy Number, providers are still encouraged to include the Billing Group Taxonomy Number on claims submissions. The Billing Group Taxonomy Number should match the provider’s Nebraska Medicaid enrollment profile. Adding the correct taxonomy will improve accuracy and timeliness of a provider’s payment.

Healthy Blue Nebraska providers are encouraged to visit Maximus to review their Medicaid enrollment profile to ensure all data is correct.

Rejection or denial code
N/A

Impacted provider specialty
N/A

Estimated claims reprocessing
N/A

Actual claims completion
N/A

Project number
N/A

Note
Healthy Blue Nebraska providers should be aware that the rendering provider’s Clinical Laboratory Improvement Amendment (“CLIA”) Number is a required field when submitting claims to Healthy Blue Nebraska. Failure to include the rendering provider’s CLIA Number will result in claim denials.

Rejection or denial code
Status code 562/ Rule 111

Impacted provider specialty
N/A

Estimated claims reprocessing
N/A

Actual claims completion
N/A

Project number
N/A

Note
Healthy Blue Nebraska requires providers to be enrolled with Anthem and submitting claims in accordance with their Nebraska Medicaid enrollment profile. Common provider data validations include NPI, taxonomy, office address including zip+4, group affiliation and corresponding enrollment effective dates.
Providers should be aware that Healthy Blue Nebraska has observed claim rejections due to the inability to correlate claim submission with a corresponding approved NE Medicaid provider record. Most frequently, this is resulting due to the lack of taxonomy being included on claims transmissions. Impacted providers are encouraged to include taxonomy on all claims being transmitted to Healthy Blue to avoid rejections. In limited instances where including taxonomy does not resolve the rejection, providers are encouraged to also include their unique NE Medicaid ID and corresponding G2 qualifier on the transmitted claim to identify the correct provider record.

Rejection or denial code
Denial: e27- Denial: e27

Impacted provider specialty
N/A

Estimated claims reprocessing
N/A

Actual claims completion
N/A

Project number
N/A

Note
Providers should be aware that Healthy Blue Nebraska will not authorize or reimburse Venipuncture & Urinalysis services supplied to Healthy Blue Nebraska members. The non-coverage of these services is supported by the Anthem Code and Clinical Editing Guidelines Reimbursement Policy:

• Venipuncture is an incidental procedure, which is performed at the same time as a more complex primary procedure and is clinically integral to the successful outcome of the primary procedure. Venipuncture is an integral step in performing any laboratory analysis of a patient's blood or serum.
• Urinalysis is an incidental procedure, which is considered an inherent component of an Evaluation & Management (E&M) service performed in an outpatient setting.

Rejection or denial code
N/A

Impacted provider specialty
N/A

Estimated claims reprocessing
N/A

Actual claims completion
N/A

Project number
N/A

Note
Healthy Blue Nebraska providers are encouraged to submit 599 Children’s Health Insurance Program (CHIP) claims as recommended below in order to improve appropriate adjudication.

A pregnant woman who is not otherwise eligible for Medicaid or Children’s Health Insurance Program (CHIP) may have her unborn child’s eligibility reviewed under the 599 Children’s Health Insurance Program (CHIP) program. When mother is ineligible, and her unborn/newborn is eligible a) The UNBORN child is the Medicaid eligible individual/subscriber and b) the mother is the patient for pregnancy related services during the pregnancy.

Before the baby is born, the subscriber eligibility will reflect “Unborn” as the first name of the subscriber. Claims with date of service prior to date of birth need to include “Unborn” as the subscriber’s first name and the typically the mother’s last name as the subscriber’s last name. (See Healthy Blue Membership ID Card for specific information)

After the baby is born, the subscriber eligibility will reflect the child’s birth name. Claims with date of service after the date of birth will use the child’s full birth name as the subscriber name. Note - Depending on the service rendered, the patient named on a claim form could be mother or child.

It is important to note that when submitting 599 CHIP claims related to newborn delivery services, please identify the newborn’s gender as identified upon birth in the corresponding fields of your respective claims.

Rejection or denial code
N/A

Impacted provider specialty
Skilled Nursing Facilities (SNF)

Estimated claims reprocessing
N/A

Actual claims completion
N/A

Project number
N/A

Note
Providers that utilize a 022X (SNF Inpatient Part B) or 023X (SNF Outpatient) Bill Type and are providing outpatient services to an inpatient Skilled Nursing Facility (SNF) resident. To prevent rejections for claims that match this bill type, Healthy Blue providers should utilize the outpatient service beginning date in the Admission Date field. This field is required to populated but will reject if an inpatient admission date is utilized.