Nebraska Medicaid: Out-of-network reimbursement requirements

Effective Aug. 1, 2025, UnitedHealthcare Community Plan of Nebraska reimbursement for out-of-network covered services will be 50% of the Nebraska Medicaid Rate in effect at the time of service.

Out-of-network referral requirements

UnitedHealthcare Community Plan of Nebraska requires prior authorization for all out-of-network referrals when providing services to Medicaid members. This excludes emergency services, family planning services, tribal services and psychiatric residential treatment facility services.

We will review out-of-network service referrals to verify medical necessity.

Providers agreeing to provide out-of-network covered services will not bill or collect payment from the member, or seek to impose a lien, for the difference between the amount paid and provider’s billed charge, or for any amounts denied or not paid.

Providers wishing to join our network can submit a request for participation through the join our network page.

Out-of-network providers are required to be enrolled with Nebraska Medicaid & Long-Term Care.

How to enroll in the Nebraska Medicaid program

You can update your existing agreement or create an account to enroll with Medicaid for the first time by logging in to the Nebraska Provider Data Management System by Maximus. If you have questions about the process, please contact Maximus customer service at nebraskamedicaidpse@maximus.com or 844-374-5022.

Questions? We’re here to help.

Connect with us through chat 24/7 in the UnitedHealthcare Provider Portal.