Qualis Health provides a broad range of services to the State of Nebraska, Department of Health and Human Services, Division of Medicaid and Long Term Care (Nebraska Medicaid). Our regional office in Lincoln is staffed by Nebraskans, whose work helps improve and advance the efficiency, economy, effectiveness and quality of healthcare services provided to enrolled Medicaid clients.
Services We Provide to Nebraska Medicaid
- Utilization management
- Prior-authorization review
- Retrospective review
- Pre-admission and concurrent review of acute inpatient rehabilitation
- Home health and private duty review
- Focused case review
- External quality review of managed care organizations
- Special projects
- Qualis Health Quarterly - March 2014
- Qualis Health Quarterly - December 2013
- Home Health Technical Denial Process - Effective Immediately
Please note the following Home Health Technical Denial Process, which takes effect immediately:
If the provider fails to submit the plan of care at the time of the home health request, a communication will be sent to the provider requesting the plan of care via iEXCHANGE® and stating "ATTENTION TECHNICAL DENIAL ALERT." Qualis Health will pend out the case for 7 days and if no record is received from the provider after the 7 days, another communication will be sent to the provider via iEXCHANGE and second set of 7 days will be given. If no response after 7 days, authorization will be technically denied for failure to follow established procedures.
In cases, where the Home Health provider submits the plan of care along with the request of services but it is felt by the reviewer that additional information is needed, the provider will be sent a communication in iEXCHANGE, requesting more information and the case will be pended out for 7 days. If there is no response at the end of these 7 days, the case will be sent to the medical director to review for medical necessity based on the information that has been received.
- Qualis Health Quarterly - September 2013
- Four of the Nebraska Medicaid provider manuals have been updated effective September 1, 2013. Download them using the links below or find them on the Provider Resources page.
- Qualis Health Quarterly - June 2013
- Qualis Health Quarterly - March 2013
- Renew your Registered Nurse License before October 31, 2012
If you have not renewed your RN nursing license, Qualis Health will not be able to authorize your Private Duty Nursing Services for service dates beyond October 31, 2012. This means your 60 day authorization period will end on October 31, 2012. This is because your Medicaid provider agreement is also set to expire on October 31, 2012.
An up-to-date license and Nebraska Medicaid provider agreement will ensure timely processing of service authorizations and claims payments.
For questions on license renewal, contact the Division of Public Health, specifically the Nursing and Nursing Support webpage.
To renew your Nebraska Medicaid Provider Agreement, please go to the Nebraska Medicaid Program Provider Information page on the Department of Health & Human Services website. You must fully complete the MC-19, attach a copy of your license and include your NPI number.
Please direct licensure and provider enrollment questions directly to the State Division of Public Health at (402) 471-3121 or on their website.
- September 2012: Make sure you have all of the required documentation for your pediatric feeding disorders treatment program prior authorization requests by using our new checklist. Download the Pediatric Feeding Requirements Checklist now or find it on the Provider Resources page under "Forms."
- Do you have questions about medical necessity criteria? If so, please visit the Nebraska Medicaid Medical Necessity Guidelines webpage.
- July 2012: The FAQs for Nebraska Home Health and Private Duty Nursing Services providers have been updated. Download the document now or find it on the Provider Resources page.
- Home Health Updates - June 2012
- A new streamlined review process for home health agencies began February 15, 2012. Read Provider Bulletin 12-06 for more information. Qualis Health provided both Gold Card Provider and Long Term Care Client Review training webinars.
View the Gold Card Provider presentation slides
View the Long Term Care Client Review presentation slides
- Home Health and Private Duty Nursing Update - January 2012
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