Nebraska Medicaid to Enforce Provider Enrollment Requirements

Effective June 1, 2025, health care providers in Nebraska must be enrolled with the State of Nebraska to be Medicaid reimbursed. This policy modification is in line with Title 471 of the Nebraska Medical Assistance Program Services, and it applies to all providers billing the UnitedHealthcare Community Plan of Nebraska Medicaid members.

Claims that are filed by providers who are not appropriately enrolled with the state will be denied under the new requirement. All providers are required to have an active National Provider Identifier (NPI), and each location where the business provides service is registered in the state to be eligible to obtain reimbursement.

Updates and enrollment requirements should be made by using the Nebraska Provider Data Management System (PDMS) that is maintained by Maximus. They are enabled to make either a new account or revise an agreement online by the providers. The new rules do not accept paper-based applications anymore.

Providers who want to have a retroactive start date to their enrollment should put this request in their online application. The home- and community-based services (HCBS) providers, however, cannot receive retroactive effective dates.

This enforcement is consistent with the actions of Nebraska to enhance program integrity and proper oversight of services under Medicaid across the state.

The providers are urged to enroll as fast as possible to prevent any form of interruption in the processing of claims and the delay of payments. All the details and enrollment procedures are provided on the Nebraska Medicaid Provider Screening and Enrollment webpage.

This is an important update to all the Medicaid-serving providers to be able to continue service reimbursement under the Nebraska Medicaid program.