Nebraska Medicaid Program

Provider Information

Radiology Prior Authorization Program

 Nebraska requires prior authorization for select radiology services. Telligen, a Utilization and Quality Management Organization, has contracted with Nebraska Medicaid to perform radiology management reviews for fee-for service clients. Telligen will review prior authorization requests for services to include: Computerized Tomography scans, Magnetic Resonance Angiogram scans, Magnetic Resonance Imaging, Magnetic Resonance Spectroscopy, Nuclear Medicine Cardiology, Positron Emission Tomography, and Single Photo Emission Computed Tomography.
The Nebraska Medicaid Practitioner Fee Schedule for Physician Services indicates codes that have prior authorization requirements and can be found at:

To request prior authorization for radiology services from Telligen, you may use the web portal , Qualitrac, 24/7 at:  Registration is required to provide access to Qualitrac. Once registration is complete, allow 2 business days before beginning upload of information into the system for prior authorization.  The provider agreement is on the Telligen website to register.  Authorizations may also be faxed to 1-855-638-8017.  For questions regarding registration or the prior authorization process for radiology, you may call Telligen at (402) 484-2740 or toll free at (855) 638-7949.

Radiology prior authorization is for Fee-For-Service Medicaid clients and will not be issued for clients who have Medicare as primary or clients enrolled in a Medicaid Managed Care Organization (MCO).  No authorization will be issued for inpatient hospital or emergency services with an emergent diagnosis. Outpatient services will require prior authorization for the select radiology services.

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