NEMT billing in Nebraska

Managed care plans arrange the rides. CMS's 2024 state tables describe Heritage Health as Nebraska's statewide full-benefit managed care program under section 1915(b) authority, started January 1, 2017, with members pre-assigned to a plan through the enrollment broker Automated Health Systems, and they mark non-emergency medical transportation as a benefit the program covers. The participating plans are Nebraska Total Care, Molina Healthcare of Nebraska and UnitedHealthcare Community Plan of Nebraska.⁷ Nebraska Total Care's transportation page says MTM provides its rides for members who do not have access to reliable transportation, cannot drive or cannot get a free ride, and UnitedHealthcare's 2026 care provider manual says non-emergency transportation for its members is provided by MTM. Each plan sets its own notice period, advance booking limit and mode rules, so the plan that holds the member decides how a trip is booked and who pays it.

Medicaid provider enrollment in Nebraska runs through the Maximus Nebraska Medicaid Provider Enrollment portal (the Nebraska Provider Data Management System)³. Heritage Health plans arrange non-emergency medical transportation as a plan benefit, and Nebraska Total Care names MTM as the vendor that books its members' rides, so a transportation company contracts with the plan's vendor rather than billing Nebraska Medicaid for trips¹.

State enrollment through Maximus first, then the vendor's network. Nebraska Total Care's credentialing page says all Medicaid providers must enroll with Maximus, through the Nebraska Medicaid Provider Enrollment portal, and that Nebraska Medicaid requires enrolled providers to revalidate every five years. UnitedHealthcare Community Plan of Nebraska has denied claims from providers who are not enrolled with the State of Nebraska since June 1, 2025; every provider needs a current National Provider Identifier, every service location enrolls separately, and paper applications are no longer accepted. The ride itself comes through the vendor: MTM's provider application page lays out six stages, the application, an interview with a network representative, contracting, credentialing when all necessary documents are submitted, training on the trip process, and the first trip, and MTM says it regularly verifies licensure, background checks, certifications, insurance requirements and vehicle inspections, stops assignments when a credential lapses, and requires yearly fraud, waste and abuse and HIPAA training for every employee.³ Nebraska Total Care's own network path, for a provider that bills the plan rather than its vendor, runs from a contract request through a credentialing application, primary source verification by Verisys and a credentialing committee decision within 60 days. UnitedHealthcare's manual states that a provider must hold a Nebraska Medicaid provider ID, so a transport company that bills a plan for any service directly keeps that enrollment current alongside its vendor contract.

• The member's name and Nebraska Medicaid identifier, the pickup and drop-off addresses, the trip date and time, and the loaded milesThe CMS provider booklet lists those five elements as the minimum every state requires on a transport record, with only the miles driven while the member was in the vehicle counted.
• The plan the member belongs to and the vendor assignment for the tripA Heritage Health ride is paid by the vendor the member's plan uses, so a Nebraska Total Care trip and a UnitedHealthcare trip are both MTM assignments but under different plan rules, and a ride booked under the wrong plan has no payer behind it.
• The booking date against the plan's notice rule, or the urgent reason for a shorter-notice tripNebraska Total Care asks for two working days and allows booking up to 60 days ahead; UnitedHealthcare asks for three days and allows 30 days ahead, with hospital discharges handled as urgent trips through MTM.
• The mode MTM assigned, including a bus pass when the member lives near a stopNebraska Total Care gives bus passes, and UnitedHealthcare makes public transit available, when the pickup and drop-off are within half a mile of a bus stop, so a vehicle trip for a member MTM assigned to transit is not a paid leg.
• The adult who accompanied a minorUnitedHealthcare requires a legally responsible adult to accompany a child under 19 and says a child aged 12 or under is not transported by a public or commercial provider without adult supervision.
• The driver's license, background check, insurance and vehicle inspection dates behind each tripMTM verifies those documents on a regular cycle and stops trip assignments when one lapses, and section 209 of the Consolidated Appropriations Act, 2021 requires every driver to hold a valid license and every provider and driver to be clear of federal health care program exclusions.

Trips are paid under your agreement with the plan's vendor, not from a Nebraska Medicaid fee schedule. Nebraska Total Care and UnitedHealthcare both route rides through MTM, whose contracting stage sets the agreement between your company and the broker, so the figure to check before each submission is the rate in that agreement for the mode and level of service MTM assigned. This page lists no HCPCS codes or rates.¹ A claim billed to a plan directly follows the plan's billing guide: Nebraska Total Care's 2026 guide pays the lesser of the billed charge or the negotiated rate, defines a clean claim as one in a nationally accepted format, coded to standard guidelines, that needs no further information from the provider, and pays finalized claims on Tuesday and Friday check runs. The NEMT billing codes page walks through the transport codes and the origin and destination modifiers in plain language.

180 calendar days from the date of service for a claim to Nebraska Total Care. The plan's 2026 provider billing guide requires all claims and encounters within 180 calendar days of the date of service, extends the window by up to 180 days when eligibility reaches the plan retroactively, gives 365 calendar days when the plan is the secondary payer, 90 calendar days from the payment or denial notice for a reconsideration or corrected claim, and 60 calendar days for an appeal.⁵ UnitedHealthcare's manual says timely filing limits vary by state requirements and contract and sends providers to their Provider Agreement for the limit, and a payment correspondence from another carrier starts the window for a secondary claim. A vendor-paid trip follows the submission terms in your MTM agreement rather than either plan's claim window.