Please follow the Enrollment Instructions below to become an electronic submitter for Nebraska Blue Cross Blue Shield.

Required Documents for those applying for new Submitter IDs

The following documents are required enrollment documents that must be completed, signed and returned to the BCBS office prior to initiation of electronic claims submission or inquiry.

1. Trading Partner Registration Form
2. Trading Partner Agreement (2 copies)

If the links above to not work properly please download them from:
http://www.bcbsne.com/Providers/Forms/

If you have any questions regarding any of the documents in this package, please Call the BCBS EDI Technology Support Center at 402-398-3603.

We can now process 276/277 requests (claim status). If this is a transaction you would like to utilize please make sure to enroll with the payer.

Trading Partner Registration

Section 1

• Enter your Provider, Practice, or Business Name

• Enter your Tax ID

• Enter the name, phone, and email of the main contact person for your office

• Enter your demographic information and contact numbers

Section 2

• Client Information

  • If you are a provider doing direct billing using ClaimShuttle you may skip this section.

  • If you are a billing service who bills for other organizations, please complete one of these for each of your clients.

Section 3

• This page is for Hospital/Institutional billing only.

  • If you are a hospital please complete this page, otherwise please skip it.

Section 4

• This page is for Individuals who will be billing professional claims electronically

• Providers billing direct – Enter the names, NPI and PIN numbers of the Physicians in your office that you will be billing for.

• Billing Services – Enter the names, NPI and PIN numbers of the Providers you will be billing for that you stated in section 3 of this form.

Press Print, then Submit

Trading Partner Agreement

Please complete the Trading Partner section on page 4 of this form with your information.

NOTE: You must complete 2 copies of this form

If you have any questions about these forms please send an email: edisupport@nebraskablue.com

Submitting your Forms

It is recommended that you keep a copy of all the forms you will be submitting for your records. Mail the enrollment forms reflecting original signatures to:

Send the Trading Partner Agreement to:

Blue Cross Blue Shield of Nebraska
Electronic Commerce
P.O. Box 3248
Omaha, NE 68180-0001

It is very important that you complete and return the entire enrollment packet as described above. Incomplete packets will not be processed and will be returned to the submitter.

Waiting for a Response

Once the complete provider enrollment packet has been received, the documents will be processed. Processing will take approximately two weeks from the date of receipt. (Remember that mailing time can take as much as five days.)

After processing, a confirmation will be faxed to you as notification to begin filing claims electronically. If neither confirmation nor a returned packet is received after two weeks, please phone the BCBS EDI Technology Support Center at 402-398-3603.

Testing

Once you have received your Submitter ID and Password from BCBS, please call the ClaimShuttle Support Team and set an appointment for a Mailbox setup and Test Transmission to BCBS.

Please have 25 test claims ready for testing. Test files should consist of a variety of claims that represent the type of claims you will be submitting once production status is achieved. Test claims will not be processed for payment but will be validated against production files; therefore, they must contain valid patient procedure, diagnosis, and provider information.