The Nebraska Health and Human Services Division of Medicaid has selected Telligen to operate the Medicaid Utilization and Quality Management Program for the State of Nebraska’s Medicaid non-managed care members. The contract with Telligen, which began December 23, 2013, is a three year agreement with two additional option periods. Telligen will begin program operations under the new contract on May 1, 2014.
Core components of the Utilization and Quality Management Program include: utilization review functions to ensure services provided to Nebraska Medicaid’s non-managed care members are medically necessary and provided in the most appropriate clinical setting; provider education activities to improve understanding and compliance with program requirements; and consulting services to provide DHHS with recommendations for program enhancements and other innovative strategies to improve care delivered to Medicaid fee-for-service members and lower the cost of care for the state.
Telligen will have a local presence with an office in Lincoln, Nebraska. Personnel working on the program will include physicians, registered nurses and other medical professionals licensed in the state.
“We are looking forward to our work with the State of Nebraska,” says Mike Speight, Telligen’s Vice President for State Healthcare Solutions. “We have experience operating similar programs in other states and are eager to begin our work with DHHS and the Nebraska provider community to help ensure that Medicaid Fee-for-service members in the state receive medically appropriate care.”