Standardized fax documents for Prior Authorization requests

Date: 11/28/23

Heritage Health (Medicaid):

Helping you care for your patient’s behavioral health needs is a top priority.

Nebraska Total Care supports the timely completion of medical necessity reviews to support high quality outcomes for our members. Providers may submit requests for services through our Secure Provider Portal (provider.nebraskatotalcare.com) or fax. To improve the efficiency of the authorization process, we have moved to a standardized fax document for authorization requests.

There will be one form for Inpatient Authorization (833-493-3345) requests and a second for Outpatient Authorizations (866-593-1955) that support both Behavioral Health as well as Physical Health authorizations. Through use of standardized forms, we reduce the number of separate forms for treatment requests and enhance the flexibility for the providers in the format of their clinical information. Guidelines on the clinical information needed for each behavioral health service type are available on our OTR Completion Tip Sheet.

Our provider website contains the new standardized forms in the Behavioral Health Provider section. If you have additional questions or need specific support, please see the Nebraska Provider Resources section of our website or call Provider Services at Nebraska Total Care .