Skip to Main Content

Update Member Assignment Limitations

What would you like to do? *

Practitioner Name

Service Location Address

Practitioner Type *
Is Practitioner Accepting New Members? *

Update Requested By

Primary Care Provider (PCP) Name

All fields are required.

If multiple practitioners' provider updates are needed, please download the Nebraska Total Care Roster Template and attach it in the upload field. All roster fields are required.

Nebraska Total Care Roster Template (Excel)
(Roster template revised 09/01/2022)

Service Location Address

Update Requested By

Primary Care Provider (PCP) Name

All fields are required.

If multiple practitioners' provider updates are needed, please download the Nebraska Total Care Roster Template and attach it in the upload field. All roster fields are required.

Nebraska Total Care Roster Template (Excel)
(Roster template revised 09/01/2022)

Service Location Address

Practitioner Type *

Update Requested By

 

This form will send your message to Nebraska Total Care as an email. The email is not encrypted and is not transmitted in a secured format. By communicating with Nebraska Total Care through email, you accept associated risks. Nebraska Total Care does not accept responsibility or liability for any loss or damage arising from the use of email.

To ensure the safety of your protected health information (PHI), please send a secure email message directly to our Contract Coordinators at NetworkManagement@NebraskaTotalCare.com while providing the Group NPI in reference.

Additionally, status updates are achieved with a direct email to our Contract Coordinators at NetworkManagement@NebraskaTotalCare.com, including the Group NPI and practitioner’s NPI(s) as applicable.