Medical Billing Services in Nebraska.
Nebraska launched its third set of Heritage Health managed care contracts on January 1, 2024—bringing Molina Healthcare and Nebraska Total Care on board while Healthy Blue Nebraska (BCBS) exited after its contract ended. UnitedHealthcare Community Plan was retained. The new 5-year contracts integrate medical, behavioral health, pharmacy, and dental coverage within a single comprehensive MCO program for Nebraska’s approximately 350,000+ Medicaid and CHIP members. Happy Billing helps Nebraska providers credential with all three Heritage Health MCOs, navigate the integrated dental benefit transition, and maximize revenue in a state with a strong rural healthcare presence.
Nebraska Medicaid (Heritage Health) Billing
Nebraska Medicaid serves over 350,000 Nebraskans as of SFY 2024—representing a roughly $4 billion annual investment in community health. Nebraska expanded Medicaid through a 2018 voter ballot initiative, with coverage (Heritage Health Adult, or HHA) taking effect October 2020. HHA brought approximately 71,000–75,000 newly eligible adults (ages 19–64 at or below 138% FPL) into Heritage Health managed care. In SFY 2024, Nebraska completed 331,522 eligibility renewals as part of Medicaid unwinding, with 110,509 members losing eligibility—mostly due to procedural reasons.
Heritage Health MCOs (Current Contracts: January 1, 2024)
Three managed care organizations serve Heritage Health members under 5-year contracts effective January 1, 2024:
- Molina Healthcare of Nebraska: New entrant replacing Healthy Blue Nebraska; national Medicaid managed care operator; Healthy Blue members who did not choose a new plan were auto-assigned to Molina on January 1, 2024
- Nebraska Total Care (Centene subsidiary): Incumbent from prior contract cycle; statewide network; strong presence in rural Nebraska communities
- UnitedHealthcare Community Plan of Nebraska: Incumbent; largest provider network; FIDE Dual Special Needs Plan (DSNP) available for dual Medicare-Medicaid eligible members
Heritage Health 2024 Contract Changes
- Dental integration: Starting January 1, 2024, MCOs are now managing dental care—previously separate; providers must credential with each MCO for dental services separately from medical
- Centralized credentialing: A new common credentialing service through Verisys (CVO) launched—single application covers all three MCOs; simplifies provider onboarding
- FIDE DSNP requirement: All three MCOs must have a Fully Integrated Dual Eligible Special Needs Plan (FIDE DSNP) in place; coordinated care for dual eligible members
- Healthy Blue exit: Healthy Blue Nebraska (BCBS) lost the contract; former Healthy Blue members auto-assigned to Molina if no new plan chosen
Long-Term Care and Fee-for-Service Carve-Outs
While Heritage Health MCOs manage most Medicaid services, the following remain fee-for-service in Nebraska:
- Long-term services and supports (LTSS): Nursing facility and home/community-based services remain FFS—billed directly to Nebraska MLTC (Medicaid and Long-Term Care)
- School-based services: Continue to be managed and reimbursed FFS outside the MCO structure
- Long-term care facilities: Nursing homes reimbursed at daily FFS rates—not through MCO capitation
Key Billing Facts for Nebraska Providers
- Centralized credentialing: Use Verisys (the contracted CVO) for a single credentialing application covering all three MCOs; must also be enrolled with KMAP (MLTC portal) separately
- Claims timeliness: Heritage Health plans must process 90% of clean claims within 15 business days and 99% within 60 calendar days; pharmacy: 90% within 7 business days, 99% within 14 calendar days
- Annual open enrollment: November 1–December 15 annually; new members may change plans within 90 days of joining Heritage Health
- Provider enrollment: Nebraska MLTC through the ACCESSNebraska portal; then credential with each MCO through Verisys
- Heritage Health enrollment phone: 1-888-255-2605
Nebraska's Major Health Systems
Nebraska Medicine (UNMC)
Nebraska Medicine is the academic health system of the University of Nebraska Medical Center (UNMC) with NPR of $1.4 billion—highest in Nebraska. Nebraska Medical Center (Omaha, 840+ beds) is Nebraska’s largest and most complex hospital: a Level I Trauma Center, the only transplant center in Nebraska (including heart, kidney, liver, pancreas, and lung transplants), home to the Fred & Pamela Buffett Cancer Center (Nebraska’s only NCI-designated cancer center), and a major infectious disease and biocontainment unit. Nebraska Medicine is the primary teaching hospital for UNMC and serves as the referral destination for Nebraska and surrounding states. All three Heritage Health MCOs maintain Nebraska Medicine as an in-network provider.
Bryan Health
Lincoln-based Bryan Health is Nebraska’s second-largest health system with Bryan East Campus NPR of $843 million. The system operates Bryan Medical Center (with Bryan East and Bryan West campuses, combined 600+ beds), Bryan Physician Network, cardiology practices, and Bryan College of Health Sciences. Bryan Medical Center is Lincoln’s primary tertiary care hospital, serving central Nebraska as the regional referral hub and offering comprehensive cardiac surgery, neurosurgery, oncology, and maternal-fetal medicine. Bryan Health is a key Heritage Health network partner for central Nebraska’s Medicaid population.
CHI Health (CommonSpirit)
Omaha-based CHI Health is the largest health system in Nebraska by number of hospitals (28 hospitals across Nebraska, Iowa, Minnesota, and North Dakota), operating as part of CommonSpirit Health. In Nebraska, CHI Health operates CHI Health Creighton University Medical Center, CHI Health Immanuel, CHI Health Midlands, CHI Health Lakeside, and multiple other Omaha-area facilities. CHI Health is a major Medicaid network provider in the Omaha metro, serving Heritage Health members through all three MCOs. The system’s affiliation with Creighton University provides medical education and research capabilities alongside clinical operations.
Methodist Health System
Omaha-based Methodist Health System (Methodist Hospital of Nebraska, NPR $625 million) operates as an independent nonprofit health system with Methodist Hospital and Methodist Women’s Hospital. Methodist Hospital is ranked among Nebraska’s top hospitals by U.S. News & World Report and serves as a key tertiary care alternative to Nebraska Medicine and CHI Health in the Omaha metro. Methodist Women’s Hospital is Nebraska’s largest dedicated women’s health facility.
Why Nebraska Practices Choose Happy Billing
Heritage Health’s January 2024 contract transition required Nebraska providers to simultaneously onboard Molina Healthcare (replacing Healthy Blue) while managing the new integrated dental benefit through all three MCOs. The dental integration was a major structural change—providers who previously billed dental separately through FFS now route dental claims through the MCO, requiring MCO-specific dental credentialing and claim routing. Add to this the centralized credentialing transition through Verisys and the Healthy Blue-to-Molina member reassignment, and January 2024 represented a significant billing workflow change for Nebraska providers. Happy Billing managed this transition and now provides ongoing Heritage Health three-MCO billing management.
- Heritage Health MCO billing for all three plans: Molina Healthcare, Nebraska Total Care, UnitedHealthcare
- Dental benefit MCO billing (integrated since January 2024) for all three Heritage Health plans
- Healthy Blue-to-Molina transition and re-credentialing management
- Nebraska Medicine, Bryan Health, and CHI Health network management
- Long-term care FFS billing for nursing facilities and HCBS waiver providers
Is your Nebraska practice leaving revenue on the table?
Specialties We Serve in Nebraska
Each specialty page dives into the specific billing challenges and our approach. Visit our Specialties to explore the one most relevant to your practice.
Nebraska Medical Billing FAQs
What changed with Heritage Health's January 2024 contract renewal?
The most significant changes in Heritage Health’s January 1, 2024 contract cycle were: (1) Molina Healthcare of Nebraska replaced Healthy Blue Nebraska (BCBS); former Healthy Blue members who didn’t actively switch were auto-enrolled with Molina. (2) Dental services were integrated into the MCO benefit—MCOs now manage dental care through their contracted dental networks (previously separate FFS). (3) A centralized credentialing organization (CVO), Verisys, was established for streamlined provider credentialing across all three MCOs. (4) All three MCOs are now required to have FIDE Dual Special Needs Plans (DSNP) for dual Medicare-Medicaid members.