Nebraska Total Care
Operated by Centene. Look up the member’s primary care assignment, referral rules, and authorization requirements in the plan’s portal before cardiac imaging or procedures are scheduled.
Cardiology billing for Nebraska practices
Remote team, statewide coverage
Cardiology medical billing services in Nebraska
Cardialogy Billing processes cardiology claims for Nebraska providers. It begins with checking if a Medicaid patient is in a Heritage Health plan or fee-for-service and covers coding, submission, denials and aging accounts.
Cardiology-specific claim review
Plan checked before each claim
No promised collection rates
Nebraska payer pathways
Heritage Health
Fee-for-service
Medicare
Commercial
Coverage firstFind the plan on file
Authorization checkConfirm payer rules
Cardiology codingReview codes against the note
Denials and A/RFollow up with a named owner
Nebraska payer knowledge
Find the right Medicaid route first
Most Nebraska Medicaid and CHIP members are enrolled in one of three Heritage Health plans. Some members and services stay in fee-for-service, long-term care among them. The member’s record on the date of service decides where the claim goes.
- Verify Medicare or any commercial coverage that pays first and process eligibility for date of service.
- Verify that the member is on a Heritage Health plan or fee-for-service.
- Separate records for tracking state Medicaid enrollment and plan credentialing.
Heritage Health
The three Heritage Health plans in Nebraska
Heritage Health is Nebraska’s Medicaid managed care program. It’s one health plan per member that integrates physical health, behavioral health, dental and pharmaceutical benefits. Each plan has its own portal, its own prior authorization list, its own claim routing, so those things are checked patient by patient.
UnitedHealthcare Community Plan of Nebraska
This is its own Medicaid product. Its policies do not carry over from UnitedHealthcare’s commercial or Medicare Advantage lines, so we read the Medicaid manual.
Molina Healthcare of Nebraska
Confirm that the practice is contracted and loaded in Molina’s system for every date of service on the claim.
Fee-for-service note: Members on fee-for-service follow a different process. Those claims use the state’s own eligibility checks, claim instructions, status lookups, and adjustment steps. Long-term care is one service that stays outside the plans.
Enrollment and credentialing
State enrollment and plan credentialing are separate steps
No Heritage Health plan will pay a provider until that provider is enrolled with Nebraska Medicaid. Enrollment alone does not put a cardiologist in the network. Credentialing is different and Verisys, a centralized verification firm, does the primary source checks for all three plans.
State enrollment
Applications are done through Maximus, the state’s enrollment vendor, and no paper applications are accepted any more. We collect information like NPI, taxonomy, specialty and location and we plan the revalidation that is due every five years.
Centralized credentialing
Verisys does the licensure, training, board certification and malpractice history checks once for all three plans. We recredential every three years by letter to the address on the provider record so we verify that it is current.
Provider data upkeep
Medicaid, plan, Medicare and commercial file comparisons include group and individual NPIs, billing and rendering links, practice locations and facility affiliations. Rejected claims are often caused by mismatched records.
Prior authorization
Confirm requirements before the test or procedure
The necessity of approval for a service varies on the payer, the product, the CPT or HCPCS code, the site of care, and the cardiologist’s network status. We don't use a set list of codes, but rather review each case against payer policy in effect at that time.
Services to review
- Stress testing and echocardiograms
- Myocardial perfusion and nuclear studies
- Coronary CTA Cardiac CT Cardiac MRI
- Diagnostic catheterization, electrophysiology and interventional procedures
Approval details must match the claim
The approved code, rendering provider, facility, and date range are matched to what was performed and documented before a claim goes out. First, it fixes a mismatch, instead of putting the onus on the payer to find.
01Request
02Record
03Match
04Track
Disclaimer: Only approval cannot be considered as a guarantee of payment. It’s still all about eligibility, codes and documentation.
Full revenue cycle support
What Cardialogy Billing handles for Nebraska cardiology practices
Each stage of the billing cycle contains a work queue to show staff what claims need to be worked today.
Eligibility and benefits verification
Verifies medicaid, Heritage Health, fee for service, medicare, commercial and secondary coverage, network status, referral requirements and authorization requirements.
Prior authorization support
Verifies if the service requires approval - Gathers clinical records - Submits and tracks each request - Attaches approval to the claim
Coding review
Reads CPT, HCPCS and ICD-10-CM options to visit note; modifiers, units and place of service.
Charge capture
Turns documented encounters and procedures into billable charges and flags anything missing before it reaches a claim.
Scrubbing claims
When submitting make sure all patient data, NPI, taxonomy, payer, codes, modifiers, referral and authorization are right.
Electronic claim submission
Sends each claim to the appropriate Heritage Health plan, state fee-for-service, Medicare contractor, commercial payer or secondary payer.
Payment posting
ERAs and EOBs, verifies contractual adjustments and patient balances, indicates payments that appear low against the contract.
Denial management
Before you submit or appeal, locate the reason for refusal, repair it, note the result and offer the practice repeat causes.
A/R follow-up
Works aging reports claim by claim, calls payers, replies demand for records and escalates anything that delays.
Credentialing and enrollment
Manages Maximus enrollment, Verisys credentialing, Medicare and commercial applications, CAQH updates as needed and revalidation dates.
Coding across specialties
Cardiology specialties we bill for
Coding is after service provided, who provided it, payer’s requirements and where the patient was seen.
General cardiology
Office visit, ECG, office testing.
Interventional Cardiology
PCI, Cath Lab Procedures and the Facility-Professional Claim Split
Electrophysiology
Pacemaker and defibrillator implantation, rhythm monitoring & ablations
Imaging authorizations and the professional and technology gap
Non-invasive and nuclear
Structural heart
Multiple doctors billing for same case.
Heart failure
Documented chronic care and remote monitoring
Medicaid and CHIP
Coverage of Children in Pediatric Cardiology
Diagnostic testing
Echo, stress, Holter and event monitor claims broken out by code.
Modifier note: Modifier 26 and TC apply only to codes with separate professional and technical components and only when the practice bills one side.
Medicare and commercial billing
Different insurance products, different rules
Original Medicare, Medicare Advantage, commercial plans, and dual-eligible coverage, and each has their own claim and authorization path.
Original Medicare
WPS Government Health Administrators processes Part A and Part B claims in Jurisdiction 5, which covers Iowa, Kansas, Missouri, and Nebraska. Local coverage determinations, medical review requests, reopenings, and appeals follow that contractor’s published guidance.
Advantage of Medicare
Each plan sets its own network, referral, and authorization rules. We confirm the exact plan on the member’s card and file appeals through that plan’s process, not Medicare’s.
Commercial and dual-eligible
Commercial claims vary on the particular product. For beneficiaries that have both Medicare and Medicaid, Medicare pays first, then the crossover claim. Then patient responsibility and any D-SNP setup is verified.
A repeatable process
How a Nebraska cardiology claim moves through our team
There is an owner for each stage, and a specified next action from the front desk to reporting.
Patient registration
Demographic and subscriber information is validated against the card.
Benefits and Eligibility
Active coverage, other insurance checked.
Identify plan
Heritage Health, fee for service, Medicare or commercial.
Network and referral
Status of participation and referral requirements are verified.
Authorization review
Current payer rules for the scheduled service are confirmed.
Documentation and coding
Codes are matched to the note and to medical necessity.
Charge capture
Every service documented is confirmed as billed.
Claim scrubbing
A final review of the provider, payer, code and claim fields.
Claim submission
The payer who owns the claim submits the claim.
Payment Posting
Posting payments and calculating patient balances
Denial Management
Denials are adjusted, appealed or resubmitted and reasons are documented.
A/R and reporting
Aging and open work are assessed periodically.
Pre-submission review
A claim checklist for Nebraska cardiology practices
Staff can use this list as a working aid. Payer rules differ by product, service, and site of care, so it does not replace the policy itself.
Pre-submission claim review
0 of 13 items checked
Challenges to watch
Where Nebraska cardiology claims tend to go wrong
Each of the six areas below has a check built into our workflow.
Plan on file
A claim is directed to one Heritage Health plan after the member has transferred to a different Heritage Health plan.
Mismatched records
The provider’s Medicaid, plan, Medicare and commercial files should all have the same NPI, taxonomy and address.
Authorization gaps
Rules change depending on payer, product, code and place of care so a response from a claim may be out of date.
Diagnostic billing
How a test is billed depends on whether it's done under global billing or split billing, who owns the equipment and the supporting paperwork among other things.
Concurrent coverage
One patient can have Medicare, Medicaid, Medicare Advantage and commercial coverage, at the same time.
Aging A/R
Claims that are not processed can go beyond the filing limits. Follow up often. Keep records
Support across Nebraska
Billing support for city, regional, and rural cardiology practices
Nebraska has sixty-four access hospitals and fifteen large urban hospitals. A cardiology practice in Omaha, Lincoln, Grand Island, Kearney or Norfolk with clinics at several of those locations can bill from several locations, integrate facility and professional claims and coordinate referrals across numerous plan networks.
Remote note: Cardialogy Billing does not have an office in Nebraska and works with Nebraska practices remotely.
Why practices outsource billing:
Less front-office time on eligibility calls and payer portals.
Authorizations and complicated coding handled by dedicated billing staff.
Denials and aged claims worked on a set schedule.
Enrollment dates tracked, with reporting that shows where claims sit.
Frequently asked questions
Nebraska cardiology billing FAQs
Short answers on payer routes, enrollment, authorization, and claim handling.
What is Heritage Health?
It is Nebraska’s Medicaid managed care program for physical health, behavioral health, dental, and pharmacy benefits. Each member is placed in one of the contracted health plans. Current plan participation should be confirmed with Nebraska DHHS before billing.
Which health plans are in Heritage Health?
Nebraska Total Care, UnitedHealthcare Community Plan of Nebraska and Molina Healthcare of Nebraska The current list is published by DHHS.
How does a cardiologist enroll with Nebraska Medicaid?
Providers enroll electronically using the state’s enrollment vendor, Maximus. Once approved, Verisys does the verification for credentialing with the Heritage Health plans and each plan does its own contracting.
Does being in the Medicaid program make a provider in network for all plans?
State enrollment is first. Then you credential and contract independently with each plan.
Who processes Original Medicare claims in Nebraska?
WPS Government Health Administrators, the Medicare Administrative Contractor for Jurisdiction 5. CMS lists the current contractor.
Can Cardialogy Billing handle Medicare Advantage and dual-eligible claims?
Yes. Those claims need the exact plan identified, then a check of network rules, authorization, payer order, and coordination of benefits.
Talk with our team
Cardiology billing support for Nebraska practices
Practices can discuss eligibility, authorization, coding, claims, denials, A/R, and provider enrollment with our team. Results depend on payer mix, documentation quality, and current workflows, and no specific financial outcome is promised.