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Authorization Tips for Providers

Date: 01/06/17

Heritage Health (Medicaid):

Please review the following information related to authorization requests. These guidelines are intended to streamline processes and minimize errors.  
 
  1. Please do not submit duplicate authorization requests. If you have submitted a request, we are reviewing the request and duplications slow down the process.
  2. In instances where a member has Medicare as their primary insurance and Medicaid is secondary payer, the authorization request does not need to be sent to Nebraska Total Care for prior authorization. Prior authorization is only necessary for services that are a non-covered benefit of Medicare, and are on the prior authorization list for Nebraska Total Care. When a member has exhausted their Medicare benefit, Nebraska Total Care does require authorization.
  3. Prior authorization is not required for medical observation until the 24th hour.
  4. Use only one method of submission. If you fax an authorization request, please do not also enter on the website.
  5. Use the Prior Authorization Tool on NebraskaTotalCare.com prior to submitting authorization to verify if authorization is needed.
  6. If you have an authorization on file from the previous MCO or the State of Nebraska, those are covered in the transition of care period. Authorization are good for 90 days, or until the date on the authorization if prior to 4/1/2017. Use this authorization until addition authorization is needed.