All of the following providers are required to be credentialed:

Medical practitioners

• Medical doctors
• Oral surgeons
• Chiropractors
• Osteopaths
• Podiatrists
• Physician Assistants
• Nurse practitioners
• Other medical practitioners

Behavioral healthcare practitioners

• Psychiatrists and other physicians
• Addiction medicine specialists
• Doctoral or master’s-level psychologists
• Master’s-level clinical social workers
• Master’s-level clinical nurse specialists or psychiatric nurse practitioners
• Other licensed behavioral healthcare specialists

All Medicaid providers must enroll with Maximus. Additionally, Nebraska Medicaid requires currently enrolled providers to revalidate every five (5) years. To complete electronic provider enrollment, revalidate or update your to existing agreement, visit Maximus.

Maximus Customer Service can be reached by phone and email:

• 844-374-5022
• NebraskaMedicaidPSE@maximus.com.

Completed paper enrollment packets can be sent to the email address above or mailed to:

Maximus Nebraska Medicaid Provider Enrollment
P.O. Box 81890
Lincoln, Nebraska 68501

All new practitioners and those adding practitioners to their current practice must submit at a minimum the following information when applying for participation with Nebraska Total Care:

• A completed, signed and dated Credentialing application
• Providers can authorize Nebraska Total Care access to their information on file with the CAQH (Council for Affordable Quality Health Care)
• A signed attestation of the correctness and completeness of the application, history of loss of license and/or clinical privileges, disciplinary actions, and/or felony convictions; lack of current illegal substance registration and/or alcohol abuse; mental and physical competence, and ability to perform the essential functions of the position, with or without accommodation (attestation must be no more than 120 days at time of submission for enrollment) – Provided to CVO
• Copy of current malpractice insurance policy face sheet that includes expiration dates, amounts of coverage and provider’s name, or evidence of compliance with Nebraska regulations regarding malpractice coverage or alternate coverage – Provided to CVO
• Hospital Admitting Privileges or alternate Admitting Arrangements – Provided to CVO
• Copy of current Drug Enforcement Administration (DEA) registration Certificate, and copy of state controlled substance certificate (if applicable) – Provided to CVO
• Copy of W-9
• Copy of Educational Commission for Foreign Medical Graduates (ECFMG) certificate, if applicable – Provided to CVO
• Curriculum vitae listing, at minimum, a five (5) year work history (not required if work history is completed on the application) – Provided to CVO
• Signed and dated release of information form not older than 90 days – Provided to CVO
• Proof of highest level of education – copy of certificate or letter certifying formal post-graduate training – Provided to CVO
• Copy of Clinical Laboratory Improvement Amendments (CLIA), if applicable – Provided to CVO
• Evidence of completion of Cultural Competency training – Provided to CVO

If applying as an individual practitioner or group practice, please submit the following information along with your signed participation agreement:

• A completed, signed and dated Credentialing application. If applying as an ancillary or clinic provider, please submit the following information along with your signed participation agreement:
• Hospital/Ancillary Provider Credentialing Application Completed (one per Facility/Ancillary Provider)
• Copy of State Operational License – Provided to CVO
• Copy of Accreditation/certification (by a nationally-recognized accrediting body, e.g. TJC/JCAHO) – Provided to CVO
  • o If not accredited by a nationally-recognized body, Site Evaluation Results by a government agency – Provided to CVO
• Copy of Current General Liability coverage (document showing the amounts and dates of coverage) – Provided to CVO
• Copy of Medicaid/Medicare Certification (if not certified, provide proof of participation) – Provided to CVO
• Other applicable State/Federal/Licensures (e.g. CLIA, DEA, Pharmacy, or Department of Health) – Provided to CVO
• Copy of W-9

If applying as a hospital, please submit the following information along with your signed participation agreement:

• Hospital/Ancillary Provider Credentialing Application Completed (one per Facility/Hospital/Ancillary Provider)
• Copy of State Operational License
• Copy of Accreditation/certification (by a nationally recognized accrediting body, e.g. TJC/JCAHO) - if not accredited by a nationally recognized body, Site Evaluation Results by a government agency
• Copy of Current General Liability coverage (document showing the amounts and dates of coverage)
• Copy of Medicaid/Medicare Certification (if not certified, provide proof of participation)
• Copy of W-9

Once Nebraska Total Care has received an application, it verifies the following information, at a minimum, submitted as part of the Credentialing process (please note that this information is also re-verified as part of the re-credentialing process):

• Current participation in the Nebraska Medicaid Program
• A current Nebraska license through the appropriate licensing agency – verified by CVO
• Board certification, or residency training, or medical education – verified by CVO
• National Practitioner Data Bank (NPDB) for malpractice claims and license agency actions – verified by CVO
• Hospital privileges in good standing or alternate admitting arrangements – verified by CVO
• Five (5) year work history – verified by CVO
• Federal and state sanctions and exclusions – verified by CVO

Nebraska Total Care will complete the credentialing process within 60 days following receipt of a complete credentialing application. This timeframe is adjusted to 60 days for the first six (6) months post implementation.

The Credentialing Committee is responsible for establishing and adopting as necessary, criteria for provider participation. It is also responsible for termination and direction of the credentialing procedures, including provider participation, denial and termination.

Committee meetings are held at least monthly and more often as deemed necessary.

Note: Failure of an applicant to adequately respond to a request for missing or expired information may result in closure of the application process prior to a committee decision.

To comply with accreditation standards, Nebraska Total Care re-credentials providers at least every 36 months from the date of the initial credentialing decision. CVO will create practitioner notification when recredentialing is due for a particular practitioner and will complete all primary source verification validations for practitioners. The purpose of this process is to identify any changes in the practitioner’s licensure, sanctions, certification, competence, or health status that may affect the ability to perform services the provider is under contract to provide. The recredentialing process includes all providers, primary care providers, specialists and ancillary providers/facilities previously credentialed to practice within the Nebraska Total Care network.

In between credentialing cycles, Nebraska Total Care conducts ongoing monitoring activities on all network providers. Staff will ensure that network providers have not incurred exclusions, licensure sanctions, illegal activity, or other negative indicators in between or prior to their standard re-credentialing through this monthly monitoring.

A provider’s agreement may be terminated at any time if the Nebraska Total Care Credentialing Committee determines that the provider no longer meets the credentialing requirements.

All Medicaid providers must enroll with Maximus. Additionally, Nebraska Medicaid requires currently enrolled providers to revalidate every five (5) years. To complete electronic provider enrollment, revalidate or update your to existing agreement, visit Maximus.

Maximus Customer Service can be reached by phone and email:

• 844-374-5022
• NebraskaMedicaidPSE@maximus.com.

Completed paper enrollment packets can be sent to the email address above or mailed to:

Maximus Nebraska Medicaid Provider Enrollment
P.O. Box 81890
Lincoln, Nebraska 68501

All providers participating within the Nebraska Total Care network have the right to review information obtained by the health plan that is used to evaluate providers’ credentialing and/or re-credentialing applications. This includes information obtained from any outside primary source such as the National Practitioner Data Bank-Healthcare Integrity and Protection Data Bank, malpractice insurance carriers and state licensing agencies. This does not allow a provider to review peer review-protected information such as references, personal recommendations, or other information.

Should a provider identify any erroneous information used in the credentialing/re-credentialing process, or should any information gathered as part of the primary source verification process differ from that submitted by the provider, the provider has the right to correct any erroneous information submitted by another party. To request release of such information, a provider must submit a written request to th Nebraska Total Care Credentialing Department. Upon receipt of this information, the provider has 14 days to provide a written explanation detailing the error or the difference in information. The Nebraska Total Care Credentialing Committee will then include the information as part of the credentialing/re-credentialing process.

All providers who have submitted an application to join Nebraska Total Care have the right to be informed of the status of their application upon request. To obtain status, contact your Provider Network Specialist at 1-844-385-2192 (TTY 711) or NetworkManagement@NebraskaTotalcare.com.

Nebraska Total Care may decline an existing provider applicant’s continued participation for reasons such as quality of care or liability claims issues. In such cases, the provider has the right to request reconsideration in writing within 30 days of formal notice of denial. All written requests should include additional supporting documentation in favor of the applicant’s reconsideration for participation in the Nebraska Total Care network. The Credentialing Committee will review the reconsideration request at its next regularly scheduled meeting, but in no case later than 60 days from the receipt of the additional documentation. Nebraska Total Care will send a written response to the provider’s reconsideration request within two weeks of the final decision.

Federal regulations set forth in 42 CFR 455.104, 455.105 and 455.106 require providers who are entering into or renewing a provider agreement to disclose:

• The identity of all owners with a control interest of 5% or greater
• Certain business transactions as described in 42 CFR 455.105
• The identity of any excluded individual or entity with an ownership or control interest in the provider, the provider group, or disclosing entity or who is an agent or managing employee of the provider group or entity

Per Nebraska Medicaid Health Plan Advisory 19-03 (PDF) all Disclosure of Ownership and Control Interest Statements must be supplied to the state’s provider enrollment contractor, Maximus. For any questions you have, Maximus Customer Service can be reached by phone and email:

• 844-374-5022
• NebraskaMedicaidPSE@maximus.com.

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.

Not part of Our Provider Network yet?

We understand that our members may elect to visit providers that are not part of Nebraska Total Care’s Provider Network. If you are not in-network, you’ll still need to know how to file claims and understand any policies and procedures that may affect you and your Nebraska Total Care member patients.

The resources found on this page contain useful information to help you interact with Nebraska Total Care.

Interested in joining our Network?

We’re always looking for high-quality providers to help care for our Members. If you are interested in joining our network call toll free 1-844-385-2192 (TTY 711) or to request a contract use our Contract Request Form or email us at NetworkManagement@NebraskaTotalCare.com.

• Become a Network Provider
• Contracting FAQ
• Contract Request Form

Helpful Resources

• Medicaid Provider Manual (PDF)
• Medicaid Provider Billing Guide (PDF)
• Medicaid Authorizations
• Medicaid Claims Payment Policies
• Provider News
• Provider Newsletters