This form can be used to record mileage for member reimbursement.
Nebraska Department of Health and Human Services Medicaid and Long-Term Care - HERITAGE HEALTH Prior Authorization for Hearing Aids
Nebraska Home Health Prior Authorization Request Form
Save time! Submit and review your requests online @ https://provider.wellcare.com
Refund Check Information Sheet* (RCIS)
Nebraska Medicaid and Long-Term Care Informed Consent Form for Treatment of Opioid Use Disorder To be completed upon initiation of therapy with Buprenorphine/Naloxone or Buprenorphine
Drug Prior Authorization Requests Supplied by the Physician/Facility
Please complete and submit this form to request coverage through the WellCare of Nebraska Medicaid plan.
Nebraska Tobacco Quitline
Chlamydia is the most common sexually transmitted bacterial infection (STI) in the United States. The best way to detect chlamydia in its early stages is to conduct screenings at yearly physicals for patients who are sexually active.