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Provider Resources

Nebraska Total Care provides the tools and support you need to deliver the best quality of care. Please view our listing on the left, or below, that covers forms, guidelines, helpful links, and training.

For Ambetter information, please visit our Ambetter website.

Heritage Health - Nebraska Total Care 

Manuals, Forms and Resources

HealthHub
Explore the collection of clinician-reviewed content by specific health conditions or concerns. Find the latest news, studies, and trending topics about health and wellness. Members can use the Symptom Checker to manage symptoms and know when to seek care.

Think Cultural Health 
A Physician’s Practical Guide for Culturally Competent Care has been updated with more interactivity, literature and references. It is accredited for AMA PRA Category 1 Credit(s) where you can earn up to 9 free CME credits (physicians and physician assistants) or 9 contact hours (nurse practitioners), while exploring engaging cases and learning about cultural competency in healthcare.

Choosing Wisely
The American Board of Internal Medicine (ABIM) Foundation encourages practitioners and patients to "Choose Wisely." This initiative seeks to advance a national dialogue on avoiding unnecessary medical tests, treatments and procedures. Choosing Wisely has downloadable informational resources for your patients and clinicians to promote shared-decision making.

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.

Provider Appointment Access Standards

Nebraska Counties Classified by Urban/ Rural/ Frontier (PDF)

Our Care Management team is available for members who may benefit from increased coordination of services. The team is available to assist and support providers with member issues including non-adherence to medications/medical advice, multiple complex co-morbidities, or to offer guidance with a new diagnosis.

The care management team helps members:

  • Achieve optimum health, functional capability and quality of life through improved management of their disease or condition.
  • Determine and access available benefits and resources.
  • Develop goals and coordinate with family, providers and community organizations to achieve these goals.
  • Facilitate timely receipt of appropriate services in the right setting.

Early intervention is essential to maximizing treatment options and minimizing potential complications associated with illnesses, injury or chronic conditions. Members can receive services through face-to-face visits, over the phone or in a provider's office. You can directly refer members to the Care Management program at any time by calling 1-844-385-2192 TTY: 711 or initiating a referral on the Provider Portal.

You Can Help Protect Your Patients and Your Community Against Respiratory Syncytial Virus (RSV)

You have the best interest of your patients at heart. More than that, you have their trust. Your patients trust you more than any other source when it comes to vaccines. And your recommendation is the most effective way to ensure they get the ones they need.

Respiratory syncytial virus (RSV) is the leading cause of childhood respiratory illness in the United States, resulting in thousands of hospitalizations and hundreds of deaths per year. Infants six months and younger are at highest risk. Prevention is essential to combat the severity of RSV. The Food and Drug Administration (FDA) has approved, and The Centers for Disease Control and Prevention's (CDC) recommends maternal RSV vaccine and the infant RSV monoclonal antibody providing two opportunities to protect against the negative side-effects of RSV.

Maternal RSV Vaccination (Abrysvo)

Pfizer’s bivalent RSVpreF vaccine, Abrysvo is the only RSV vaccine approved for use during pregnancy.

  • A single injection given to pregnant individuals at 32 weeks through 36 weeks gestational age have shown reduction in severe RSV infection in infants by 81% within 90 days of life, and 69% within 180 days of life.
  • Should be given seasonally, September through January.
  • May administer with other vaccines recommended during pregnancy, such as flu, COVID-19, and Tdap.
  • Provides protection for infant if maternal vaccination occurred at least 14 days prior to birth.
  • Common side effects include injection site pain, headache, muscle pain, and nausea.

Infant RSV Monoclonal Antibody (Beyfortus, nirsevimab)

  • A single intramuscular injection for infants younger than 8 months of age born during or entering into their first RSV season to prevent severe RSV disease.
  • Available for infants if maternal RSV not given or if vaccine was given but delivery occurred prior to 34 weeks gestation.
  • The RSV vaccine has shown an 80% reduction in RSV-related healthcare visits and hospitalizations.

Want to Learn More?

Access the Centers for Disease Control and Prevention's Recommendations for Use of Nirsevimab for the Prevention of RSV Among Infants and Young Children.

View The American College of Obstetricians and Gynecologists (ACOG) clinical guidance on Maternal Respiratory Syncytial Virus Vaccination.

Contact your Provider Relations team for additional information and answers to coding and billing requirements.