Utilization Management

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Medicaid & Long-Term Care
 
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What you need to know


Nebraska Medicaid's Utilization Management Contractor, eQHealth Solutions, has been acquired by Kepro, a Peer Review Organization.  The services provided for Nebraska Medicaid by eQHealth Solutions and the branding will remain unchanged.

Provider portal training is available on Nebraska DHHS' Youtube channel and through eQHealth's comprehensive user guide​.

eQHealth Solutions will provide the following services to Medicaid providers:

  • Inpatient Acute Care Hospital Retrospective Reviews
  • Outpatient Acute Care Hospital Retrospective Reviews
  • Inpatient Acute Care Hospital certified as Critical Access Hospitals Retrospective Reviews
  • Outpatient Acute Care Hospital certified as Critical Access Hospitals Retrospective Reviews
  • Acute Inpatient Rehabilitation Service Prior Authorization for Admission Reviews
  • Acute Inpatient Rehabilitation Service Concurrent Reviews
  • Home Health Care Prior Authorization for Admission Reviews
  • Home Health Care Concurrent Reviews
  • Private Duty Nursing Services Prior Authorization for Admission Reviews
  • Private Duty Nursing Services Concurrent Reviews
  • DME & Hearing Devices Prior Authorization Reviews
  • Inpatient and Home Hospice Prior Authorization for Admission Reviews
  • Inpatient and Home Hospice Recertification Reviews
  • Cost Outlier Reviews
  • Ambulatory Surgical Center Retrospective Reviews
  • Solid-organ, blood/stem cell Transplant Prior Authorization Reviews
  • Cosmetic surgery for particular procedures Prior Authorization Reviews
  • Special Needs Facility Prior Authorization for Admission Reviews
  • Special Needs Facility Recertification Reviews
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Medicaid rates and fee schedules are available below:

Authorization Process for Special Needs Facilities FAQ

 Prior Authorization Fax Form

 Utilization Management Contact Information
Phone Number: eQHealth Solutions
(888) 498-0939
Fax Number: eQHealth Solutions
1 (800) 316-0021