Q: Who can contract with Nebraska Total Care?
A: Nebraska Total Care is committed to providing a comprehensive network with the best possible access for members. The provider must enroll as a Medicaid with provider with the State of Nebraska, Division of Medicaid & Long-Term Care provider enrollment vendor, Maximus. Enrollment with Nebraska Total Care and Maximus can occur simultaneously, but per state requirements Nebraska Total Care will be unable to pay any provider not enrolled with Nebraska Medicaid. Information on provider screening and enrollment can be accessed at the Medicaid and Long Term Care website.
Q: What is the difference between “credentialing” with Nebraska Total Care and “enrollment” with Maximus?
A: Enrollment with Maximus reviews the limited criteria and assigns a Nebraska Medicaid Provider ID. Credentialing with the Health Plan validates CAQH data, including licensure, education, work history, board certification, insurance, sanctions and disclosure of ownership.
Q: What are the required credentialing elements for an individual practitioner?
A: A roster including CAQH ID, attestation, hospital privileges, work history, licensure, board certification, education, sanctions validation, malpractice history, liability coverage, DEA certificates, and CLIA certificate.
Q: What is the credentialing elements for an organization?
A: Facility application, attestation, proof of Accreditation or CMS audit or site visit, liability coverage, sanctions validation, licensure, CLIA certificate, and DEA/CSR certificate.
Q: What is CAQH?
This is a free secure repository where healthcare providers can easily self-report data that Nebraska Total Care requires credentialing and re-credentialing. For example, licensure(s), curriculum vitae, IRS W-9 Form, DEA certificates, etc. Most insurance carriers use this as their source of truth, and it can be a valuable, time saving tool for practitioners and the facilities they are affiliated with. For more information, visit the CAQH Solutions website.
Q: How long does it take to get contracted and credentialed with Nebraska Total Care?
A: Once a completed contract and all credentialing information/documentation are received by Nebraska Total Care, the entire process takes up to, but no longer, than 30 days.
Q: Who do I follow up with regarding questions and status updates on our contract/credentialing?
A: Please reach out via email to NetworkManagement@NebraskaTotalCare.com The email box is checked daily and you can anticipate a response within two (2) business days.
Q: How am I informed that I am credentialed with Nebraska Total Care?
A: Once credentialing is completed, you will receive an approval or declination letter. If you disagree with the decision, appeal rights and steps are outlined on the documentation you will receive.
Q: If we have someone who is already credentialed with another clinic/location, how do we add that provider to a different practice?
A: Please submit a revised roster to request the additional location be added. Credentialing is at the practitioner level. When the practitioner credentialing is approved, that credentialing will remain valid until the re-credentialing period, which is 3 years after initial credentialing.
Q: What is the process to add new practitioners to a contract?
A: A revised roster will be required to add practitioners to the contract. If it is a completely new location, a Facility application along with an IRS W-9 Form will be required.
Q: When should I anticipate an orientation?
Within 30 days of an executed contract, your assigned Provider Relations Representative will reach out to you to welcome you to Nebraska Total Care and provide a detailed orientation.