Section 6401 of the Affordable Care Act lists certain Medicaid provider screening and enrollment requirements states must follow. The requirements can be found in 42 CFR 455 Subpart E.
Nebraska Medicaid must follow these requirements to comply with federal law, which apply to all providers. Current providers will be required to revalidate their agreements.
All newly enrolling, re-enrolling, reactivating, and revalidating institutional providers, including providers enrolled as groups, are required to pay an application fee. The Centers for Medicare and Medicaid Services (CMS) determines the application fee each year. The fee for 2019 is $586.
The fee is not required to be paid to Nebraska Medicaid if the provider is already enrolled in Medicare, or has paid the fee to Medicare or another state Medicaid program.
Verification of provider license in any state the provider is licensed, including a determination of whether the license has any restrictions.
All provider types must be assigned a risk level based on the risk each provider type poses for committing fraud, waste, or abuse against the Medicaid program.
Provider Screening Risk Levels
DHHS must deny or terminate from the Nebraska Medicaid any provider if:
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