Nebraska Medicaid approved the Centralized Verification Organization (CVO) selection by the three Nebraska managed care organizations (Nebraska Total Care, Molina Healthcare and United Healthcare Community Plan) of the shared CVO vendor, Verisys.

Beginning January 1, 2025, providers seeking initial credentialing with any managed care organization for Nebraska Medicaid will use the newly implemented centralized credentialing process along with an NCQA certified Centralized Verification Organization (CVO). The CVO, Verisys, will conduct one streamlined verification process for all three Nebraska Managed Care Organizations (MCO). A Centralized Credentialing system eliminates the need to perform a unique credentialing process with each MCO and is in alignment with the State of Nebraska’s intent to alleviate the duration and reduce administrative burdens of the MCO-specific credentialing processes.

Providers required to participate with the centralized credentialing process are Medical, Behavioral Health, Substance Use/Abuse, and Dental providers. If the MCO delegates credentialing to a national vendor e.g. physical health, routine vision, pharmacy, non-emergency medical transportation (NEMT) providers or other entities including Independent Physician Practice Associations (IPA) and Physician Hospital Organizations (PHO) who hold delegated credentialing agreements, these vendors and delegates will be excluded from the centralized CVO.

Recredentialing will begin later in 2025. The CVO will perform recredentialing for providers every three (3) years unless the provider is credentialed by a Nebraska approved vendor or delegated credentialing entity. Providers identified for credentialing will receive notification from Verisys by letter, which is sent to the providers “mail to” address on their provider record. A letter will be generated six months in advance of the credentialing due date, alerting you to the start of the credentialing process.

This process adheres to NCQA and CMS federal guidelines for both processes and the types of providers who are subject to the credentialing process. The following items are required to begin the credentialing process:

  • A completed CAQH application, include Attestation Statement
  • Current medical license, when applicable
  • Current DEA certificate, when applicable
  • Current professional liability insurance

The CVO will verify using primary sources licensure, education and training, board certification and malpractice claims history.

Please note that centralized credentialing does not replace the Medicaid provider enrollment screening process. All Medicaid providers must enroll with the program through Maximus. More information on how to enroll in the Nebraska Medicaid Program can be found here: Maximus Contact Information

Mark your calendar for upcoming Centralized Credentialing webinars.

NEBRASKA MCOs PROVIDER TRAINING DECK (FOR REFERENCE)

The MCO’s in partnership with Verisys will be hosting provider webinars for Centralized Credentialing.  All trainings will be one hour virtual sessions and will occur on the following dates and times:

December 10, 2024 at 1 pm CST Zoom Meeting ID: 929 7073 2218
Passcode: 995317
Phone:  646-931-3860

January 15, 2025 at 3 pm CST Zoom Meeting ID: 974 9633 5119
Passcode: 605416
Phone: 646-931-3860

For more information, please reach out to your respective MCO’s Network contacts.