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Contracting and Credentialing

The purpose of the credentialing and re-credentialing process is to help Nebraska Total Care maintain a high-quality healthcare delivery system. The credentialing and re-credentialing process helps achieve this objective by validating the professional competency and conduct of our providers. This includes verifying licensure, board certification, and education, and identification of adverse actions, including malpractice or negligence claims, through the applicable state and federal agencies and the National Practitioner Data Bank. Participating providers must meet the criteria established by Nebraska Total Care, as well as government regulations and standards of accrediting bodies, and must be enrolled with Nebraska Medicaid.

Nebraska Total Care requires re-credentialing at a minimum of every 3 years because it is essential that we maintain current provider professional information. This information is also critical for Nebraska Total Care members, who depend on the accuracy of information in the provider directory.

Note: In order to maintain a current provider profile, providers are required to notify Nebraska Total Care of any relevant changes to their credentialing information in a timely manner.

Contracting and Credentialing Representatives are available to help address any questions related to the terms of your provider agreement or credentialing requests. Representatives are assigned to specific regions. To locate your representative, please see the Contracting Representative Territory Map (PDF).

Network Status Updates: To request the processing status of a network update (billing address change, practitioner load, service location change, name change, etc.) email our Contract Coordinators at NetworkManagement@NebraskaTotalCare.com. Please provide the Group NPI (Type 2 NPI) and the practitioner’s NPI(s) as applicable.

Contracting Representatives

Territory Map. Contracting Reps. For assistance, contact 1-844-385-2192, Relay 711 

Areas Counties  Contracting Rep
Area
1
Sioux, Dawes, Box Butte, Sheridan, Scotts Bluff, Banner, Kimball, Morrill, Cheyenne, Garden, Deuel, Keith, Perkins, Lincoln, Chase, Hayes, Dundy, Hitchcock, Red Willow, Dawson, Buffalo, Hall, Frontier, Gosper, Phelps, Kearney, Adams, Furnas, Harlan, Franklin, Webster, Hamilton, Clay, Nuckolls, Seward, Saunders, Filmore, Thayer, Saline, Jefferson, Lancaster, Gage, Otoe, Johnson, Nemaha, Pawnee, Richardson
Michelle Haywood
Michelle.L.Haywood@NebraskaTotalCare.com
402-401-4876
Area
2
Grant, Arthur, Hooker, Thomas, Blaine, McPherson, Logan, Custer, Loup, Garfield, Wheeler, Valley, Greeley, Sherman, Howard, Merrick, Cherry, Keya Paha, Boyd, Brown, Rock, Holt, Knox, Cedar, Dixon, Dakota, Antelope, Pierce, Wayne, Thurston, Boone, Nance, Madison, Platte, Stanton, Colfax, Cuming, Burt, Dodge, Washington, Douglas, Sarpy, Cass,  Polk, York, Butler
Nic Zajac
Nicholas.M.Zajac@NebraskaTotalCare.com
531-329-8536

Tim Easton
Sr. Director, Contracting & Network Development
Timothy.Easton@NebraskaTotalCare.com
Cell: 402-594-6817

Pharmacy Providers
Envolve Pharmacy
800-974-5268

MTM Non-Emergency Medical Transportation
TRecruiting@MTM-Inc.net

Routine Vision Providers
Envolve Vision

New contract requests: ProviderContracts@EnvolveHealth.com
Existing provider inquiries: Envolve_AdvancedCaseUnit@EnvolveHealth.com
800-531-2818