Behavioral Health

Nebraska Total Care covers all behavioral health services that are included in the Heritage Health plan. A complete list of services, CPT codes, and authorization requirements can be found on the Pre-Auth Check page here

An overview of our integrated health program can be found on the Behavior Health Provider Resource Guide.

Attention All Outpatient Behavioral Health Providers: The provider portal enhancements are complete. 

BH Providers are able to submit electronic authorization requests for the following services:

  • Community Based Service
  • Day Treatment
  • ECT (Electroconvulsive Therapy)
  • IOP  (Intensive Outpatient Therapy)
  • Psychological Testing
  • Psychiatric Evaluation  

*All other higher levels of care require prior authorizations to be submitted via fax.

All BH providers are able to see their authorizations on the provider portal. 

Fax to 866-535-6974

  • Certificate of Need
  • Discharge summaries
  • Inpatient clinical documentation

Fax to 866-593-1955

  • Outpatient Treatment Requests
  • Outpatient clinical documentation

Medical Necessity Determinations

For Medical Necessity determinations for behavioral health services, Nebraska Total Care uses InterQual, American Society of Addition Medicine (ASAM), and Community Based Medical Necessity Criteria (MNC) based on the Nebraska Medicaid Service Definitions which can be accessed by visiting http://dhhs.ne.gov/medicaid/Pages/medHHBHIntegrationAdvisory.aspx