Medical Billing in Nebraska

What is specific to Nebraska

Nebraska Medicaid runs through the Heritage Health programme, which combines physical health, behavioral health and pharmacy benefits under a small number of contracted plans, so enrollment with each plan governs whether claims pay.

Nebraska’s Medicaid programme is Nebraska Medicaid. Practices with a meaningful Nebraska Medicaid mix usually need it worked as its own queue rather than mixed into commercial follow-up, because the submission path, the timely filing window and the appeal route are all different.

What a medical billing seat does in Nebraska

Aged accounts receivable called until they close, and denials read, appealed and tracked.

In Nebraska the queue that costs the most is Nebraska Medicaid, because its filing window and appeal route are not the commercial ones.

• Worklist worked from the difficult end, not the easy end
• Every call logged with the payer reference and the outcome
• Denials categorised so the same reason stops recurring
• Appeals written and submitted, not just re-bills
• Weekly written summary of what moved and what did not
• Worked during Nebraska business hours, not queued overnight

Most of the Nebraska work we see comes out of Omaha, Lincoln and Bellevue, though nothing about a seat depends on where your office is — the queue is worked through your system, not from your building.

Nebraska borders 6 states, and practices near those lines almost always carry at least one out-of-state Medicaid enrollment. That is a separate portal, a separate filing window and a separate appeal route from Nebraska Medicaid, and it is the queue that most often goes unworked because it belongs to nobody.

What Nebraska law gives you

30 calendar days for electronic clean claims; 45 calendar days for non-electronic clean claims

Source.

Nebraska Medicaid, in practice

Statewide managed care through Heritage Health with three MCOs — the state page reads "Heritage Health, Nebraska's Medicaid managed care program that combines the majority of Nebraska's Medicaid services into a single comprehensive system for Nebraska's Medicaid and CHIP members" and lists contracts for "Molina Healthcare", "Nebraska Total Care" and "UnitedHealthcare Community Plan". Source

Nebraska Medicaid runs an unusually short timely-filing window: 471 NAC 3-003 requires that "No more than 6 months have elapsed from the date of service when the claim is received by the Department", with a hard outer wall that "The Department will not pay claims received more than two years after the date of service, except under the circumstances specified in this chapter." Six months is half the 12-month filing limit most state Medicaid programs use. Source

On the commercial side the dominant Blue plan here trades as Blue Cross and Blue Shield of Nebraska (BCBSNE), which matters mainly because its portal and its appeal route are the ones your seat will spend the most time in. Source

We have not been able to source Nebraska’s own Medicaid filing limit from the regulation itself, so this page does not quote one — the federal floor is twelve months from the date of service and a state may set a shorter window. Ask your Nebraska Medicaid representative for the figure in writing before you rely on it. The states we could source are listed here.

Working Nebraska hours

Nebraska runs on Central time, 11 hours behind our floor in Rawalpindi. To be at a desk for your nine to five, the shift here runs 8pm to 4am, and 7pm to 3am once the clocks go forward. Pakistan does not observe daylight saving, so the shift moves on this side rather than yours.

One wrinkle worth naming: the western panhandle runs on Mountain time. If your practice sits on that side of the line, say so on the call and the shift is set to your clock rather than the one most of the state keeps.

That is the part that decides whether follow-up happens at all: a payer’s phone lines are open on Nebraska hours and nobody else’s.

What it costs in Nebraska

$1,650

Per seat, per month, in US dollars — $19,800 a year for one full-time person, forty hours a week, on Nebraska hours. No annual contract, no percentage of collections, no setup fee and no software to buy. Seat prices across all roles in Nebraska run $1,450 to $2,400; the full list is published.

That is the entire invoice. Run your own figures against a percentage vendor or a hire rather than take ours.

Getting started in Nebraska

About a week from a signed agreement to a person working your queue, and that week of training on your workflow is not billed on top. The work happens in your own system under a login you issue, so there is nothing to migrate and nothing to install. The week, step by step, and what is signed before anyone has access.

Questions