Provider Screening and Enrollment

 
2
Medicaid Related Assistance
Medicaid & Long-Term Care
 
Share
No
No

What would you like to do?

What you need to know

​​​​​​​​​​​​​​​​​​​​​Providers interested in enrolling with Nebraska (NE) Medicaid must complete an application.  Most providers can complete this process online. Home and Community-Based Service (HBCS) providers should review Provider Enrollment for Home and Community-Based Services Providers webpage. Providers must be enrolled as a Medicaid provider to receive payment from NE Medicaid. Once the application is received, the Provider Relations team determines if the provider is eligible to supply Medicaid services to Nebraskans.

The enrollment process can vary based on the services the provider is enrolling in and the risk level of those services.​Additional information based of the services offered by each provider type can be found on the NE Medicaid Provider Handbook webpage.

Provider reimbursed under the Fee-for-Services (FFS) model are separately paid for each service they perform.  Provider Reimbursement rates can be found on our Provider Rates and Fee Schedules Page. ​


Sections on this page

    How to Enroll in the Nebraska Medicaid Program

    All Medicaid providers must be enrolled to provide Medicaid services in Nebraska. Maximus, the enrollment contractor for the Nebraska Department of Health and Human Services (DHHS), gathers and screens the information entered into their system.  The Provider Relations team reviews and approves the provider's enrollment. ​

    Tip

    Providers can enroll for the first time or update their existing agreement by visiting Maximus's website. Questions about the process should be directed to Maximus Customer Service. Maximus can be reached by phone and email:

    Provider Resources​​

    Additional Resources

    ​Below are some links to additional resources that may be helpful for Medicaid Providers.

    Read MoreShow Less

    Frequently Asked Questions​​

    I have a question, who do I contact?

    Please refer to our contact directory​ for a list of best contacts.  If you still have questions or are unsure who to contact, please reach out to the provider relations team using the contact information listed below.

    Do I have to credential with each Managed Care Organization?

    Yes, after a provider is enrolled with the Nebraska Medicaid Program they contract with each Managed Care Organization (MCO) to be reimbursed for services provided to members under each MCO. More information on Nebraska Medicaid's MCOs can be found here.

    I received a letter, what do I do?

    Please take the time to read the letter carefully. If you have questions, any letter providers receive from the Provider Relations team about Provider Screening and Enrollment will have the necessary contact information in the letter.

    While we try to give clear directions and explanations, we understand that the process can be confusing.  If that is the case, please call us at 402-471-9018 and leave a detailed message about the letter you received, including the date of the letter, the provider's name, and a good callback number.

    What is the difference between enrollment, renewal, and revalidation?

    • Enrollment: ​This is when providers enroll for the first time to be a Medicaid provider. The enrollment process may be completed a second time if the provider was enrolled with the program but their agreement closed for any reason.​
    • Renewal/Annual Screening (HCBS Providers only): This happens yearly, typically at the time of the provider's initial enrollment. During the renewal process, all of the provider's information on file with the program is reviewed.
    • Revalidation: This happens every 5 years from the time of the provider's initial enrollment. The revalidation process is similar to completing another enrollment but it is to update the program with any changes that could have happened in the last 5 years.

    How do I know it's time to revalidate my agreement?

    Providers should keep their contact information, such as phone, email, and address, up to date.  Maximus will use the contact information listed in their system to send notices by email as early as 180 days before revalidation to providers.

    Additional emails are sent in the months leading up to the provider's revalidation date.  If Maximus cannot contact the provider by email, a letter will be sent to the address listed in their system.

    How do I revalidate my enrollment?

    Once it is time for a provider to revalidate their enrollment, they must log into the Provider Data Management System (PDMS portal) in Maximus ​to review their information and make any necessary updates or changes. Then, they must submit their enrollment to start the revalidation process.  

    Provider types that are considered a "high risk" according to the Nebraska Medicaid Provider Risk Level will receive a Fingerprint Criminal Background Check (FCBC) packet from the Provider Relations team. The packet contains information on how to complete the fingerprint background check.​

    How do I get a National Provider Identifier (NPI)?

    Providers can register for an NPI on the National Plan & Provider Enumeration System website here.

    How do I complete the Fingerprint Criminal Background Check​?

    ​Provider types that are considered "high risk" must complete a Fingerprint Criminal Background Check during their enrollment. If a provider does not complete the background check within the allotted time​, their Medicaid enrollment will be denied or terminated.  

    More information on the process can be found in the Fingerprint Criminal Background Check​ packet​​.​​​​​

    Cost of Fingerprinting

    It costs $45.25 to complete the background check with NSP. NSP does not require an additional charge ​​for the service, other locations may charge an additional fee.

    Providers can submit their payment for the background check online at: http://www.ne.gov/go/nsp​.​

    How long will the process take?

    After your prints and payment have been received, the process may take up to 4-6 weeks for the results of your criminal background check to be received by MLTC.

    How do I appeal a provider eligibility determination?

    If a provider's Medicaid enrollment is denied, they may challenge that decision by requesting an appeal. The case will be reviewed by a DHHS Hearing Officer.  Providers may represent themselves or ask someone to assist with the process.

    At the hearing, both sides present evidence that supports their case. All appellants have the right to have a witness testify.  Anyone who testifies can be asked questions by both sides present. Once the hearing is complete, the Hearing Officer makes a recommendation to the Medicaid Director and the director makes the final eligibility determination.

    471 NAC Chapter 2.007 APPEAL RIGHTS. Any adverse action under Title 471 NAC may be appealed to the Medicaid Director by the person or entity against whom the action was taken.  

    007.01 HEARING REQUEST PROCEDURE. The person or entity appealing an adverse action must submit a written hearing request to the Medicaid Director.  

    007.01(A) DEADLINES. The following deadlines apply when submitting an appeal request:  

    1. Administrative sanctions must be appealed within 30 days of the date of the action;  
    2. Refund requests must be appealed within 30 days of the date of the action; and  
    3. All other actions must be appealed within 90 days of the date of the action.  

    To submit a Request to Appeal, a written request for a hearing may be submitted to the MLTC Appeals Coordinator, P.O. Box 94967, Lincoln NE 68509-4967. The request must identify the basis of the appeal. At that time, documentation or written arguments against the denial can be submitted. 

    Read MoreShow Less
    More information on the appeal process can be found here​.

    I have questions about my taxes and being a provider.

    For more information on taxes, please see our FAQ for tax forms.

    Besides direct deposit, is there any other way I can be paid for services?

    Medicaid providers have the option to receive their payment via Direct Deposit.  

    Home and Community Based Service providers have the option to receive payment via ReliaCard. Disclosures related to ReliaCard payment election can be found here. 

    Where can I find more information on submitting claims?

    Information on submitting claims, adjustment requests, or managing denied claims can be found online at https://dhhs.ne.gov/Pages/Med​icaid-Provider-Claims-Processing-FAQ.aspx​​.​​​

    Who do I contact with questions regarding billing for claims?

    • Fee-for-Services: Please have the Medicaid member's ID and dates of service ready.
    • Managed Care Organizations (MCO): Please contact the MCO you are billing.
    • Home and Community Based Services: Please have the provider ID and dates of service ready or include them in the email.

    Do providers need to be enrolled for each location they practice at?

    Yes, providers need to enroll separately for each location where they are providing services to Medicaid members.

    How do I request a retroactive start date?

    If a provider wants to request a retroactive start date, they should do so at time of enrollment. HCBS providers cannot receive a retroactive start date.

    I was enrolled as a provisionally licensed provider but have now received my license, is there anything else I need to do?

    Yes, you must close your provisional enrollment and re-enroll based on your new license as soon as possible. You cannot be reimbursed under your new license until a new enrollment is complete.

    ​​​

    Contact Us

    ​Medicaid Provider Relations
    Division of Medicaid & Long-Term Care / Department of Health & Human Services
    Phone Number
    (402) 471-9018
    ​