Nebraska Department of Health and Human Services, Division of Medicaid and Long Term Care

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
  • Reconsiderations
  • Appeals
• Focused case review
• External quality review of managed care organizations
• Special projects

Announcements

• Qualis Health Quarterly - March 2013
• January 2013: The provider manual for Inpatient/Outpatient Services Provided at a Critical Access Hospital has been updated. Download it here or find it on the Provider Resources page.
• Qualis Health Quarterly - December 2012
• Renew your Registered Nurse License before October 31
  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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