How to become a Medicaid provider in Nebraska
To bill Nebraska Medicaid, enroll through Maximus Provider Data Management System (PDMS), run by Maximus is the enrollment and screening contractor. DHHS's page sends fee-for-service claim questions to Nebraska DHHS Medicaid Claims Customer Service and names no separate claims fiscal agent.. The process has 5 steps, listed below with the documents the state asks for.
- Enrollment portal
- Maximus Provider Data Management System (PDMS)
- Steps
- 5
- Documents
- 3
- Plans listed
- 3
On this page
Nebraska Medicaid enrollment at a glance
To bill Nebraska Medicaid, enroll through Maximus Provider Data Management System (PDMS), run by Maximus is the enrollment and screening contractor. DHHS's page sends fee-for-service claim questions to Nebraska DHHS Medicaid Claims Customer Service and names no separate claims fiscal agent.. The process has 5 steps, listed below with the documents the state asks for.
- Program
- Nebraska Medicaid (Heritage Health managed care), Division of Medicaid & Long-Term Care, Nebraska DHHS
- Enrollment portal
- Maximus Provider Data Management System (PDMS)
- Fiscal agent
- Maximus is the enrollment and screening contractor. DHHS's page sends fee-for-service claim questions to Nebraska DHHS Medicaid Claims Customer Service and names no separate claims fiscal agent.
- Application fee
- Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts. Nebraska's screening and enrollment page does not list a separate state fee. The $55 fingerprint check is a separate cost (see fingerprinting).
- Fingerprinting
- Provider types that fall in the 'high risk' level of the Nebraska Medicaid Provider Risk Level list must complete a Fingerprint Criminal Background Check, both at enrollment and at revalidation. DHHS Provider Relations sends the packet. The check costs $55 through the Nebraska State Patrol; other fingerprint sites may add a fee. Under federal rules (42 CFR 455.434 and 455.450), the state places provider types in 'limited', 'moderate' or 'high' risk levels. High-risk providers, and anyone who owns 5% or more of one, must submit fingerprints for a criminal background check.
- Site visit
- Under federal rule (42 CFR 455.432), the state must visit moderate- and high-risk providers before and after enrollment. Every enrolled provider must allow unannounced on-site inspections. Nebraska's enrollment page does not describe a state-specific site visit process.
- Revalidation
- Every 5 years from the date of first enrollment. Maximus emails a notice as early as 180 days before the due date and sends reminders after that. The provider logs into PDMS, updates the record and submits it. Federal rule (42 CFR 455.414) requires the state to revalidate every enrolled provider at least once every 5 years.
- Provider manual
- Provider manual
Steps
- Get an NPI from NPPES
- Enroll online in Maximus PDMS. Paper applications have not been accepted since June 1, 2025
- High-risk provider types complete the fingerprint criminal background check packet sent by Provider Relations
- Maximus screens the application, and DHHS approves or denies it. A denial can be appealed
- After state enrollment, contract with each Heritage Health plan you want to join and go through centralized credentialing
Documents the state asks for
Joining managed-care plan networks
- Credentialing
- Joining PDMS is the first step only. A provider must then contract separately with each Heritage Health plan it wants to serve (one, two or all three) and meet that plan's credentialing standards. Since January 1, 2025, medical, behavioral health and dental providers must use centralized credentialing; Heritage Health uses Verisys as its central verification organization. Centralized credentialing: yes (the plans still contract separately).
- Plans (state list)
- Nebraska Total Care
- UnitedHealthcare Community Plan of Nebraska
- Molina Healthcare of Nebraska
Frequently asked questions
How do I become a Medicaid provider in Nebraska?
To bill Nebraska Medicaid, enroll through Maximus Provider Data Management System (PDMS), run by Maximus is the enrollment and screening contractor. DHHS's page sends fee-for-service claim questions to Nebraska DHHS Medicaid Claims Customer Service and names no separate claims fiscal agent.. The process has 5 steps, listed below with the documents the state asks for.
Is there an application fee to enroll in Nebraska Medicaid?
Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts. Nebraska's screening and enrollment page does not list a separate state fee. The $55 fingerprint check is a separate cost (see fingerprinting).
How often must Nebraska Medicaid providers revalidate?
Every 5 years from the date of first enrollment. Maximus emails a notice as early as 180 days before the due date and sends reminders after that. The provider logs into PDMS, updates the record and submits it. Federal rule (42 CFR 455.414) requires the state to revalidate every enrolled provider at least once every 5 years.