Contractor Enrollment

Contact Lisa Oberg at 402.881.1452 for questions or updates.

 

Contractor Enrollment Process Document

2023 Contractor Vendor Approval Process.pdf

 

Attachments

Attachment A 2023 Contractor Packet Intro Email.docx

Attachment B 2023 Contractor Packet Into Letter.doc

Attachment C 2023 Contractor Zoom Meeting Confirmation Email.docx

Attachment D 2023 Annual Bkgd Check Request Email.docx

Attachment E 2023 Annual Bkgd Check Request Letter.doc

Attachment F 2023 5 yr Renewal Request Email.docx

Attachment G 2023 5 yr Renewal Request Letter.doc

Attachment H 2023 Contractor Initial Welcome Letter.doc

Attachment I 2023 Contractor 5 yr Revalidation Approval Letter.doc

Attachment J 2023 Contractor Ineligible Letter_Criminal Convictions.doc

Attachment K 2023 Contractor Ineligible Revalidation Email.docx

Attachment L 2023 Contractor Ineligible Revalidation Letter.doc

Attachment M 2023 Contractor Guide.docx

Attachment N NEnewhire test.pdf

 

Contractor Enrollment Documents

1_2022 Contractor_Vendor Information Form.pdf

2_Nebraska DOL Contractor Registration.pdf

3_MC199Provider Release of Info_Felony_Misdemeanor Statement.pdf

4_MLTC62N Nebraska Ownership_Controlling Interest and Conviction Disclosure.pdf

5_fw4.pdf

6_ MC-19Nebraska Service Provider Agreement.pdf

6_MC19Inst Nebraska Service Provider Agreement Instructions.pdf

7- NDE ACH__W9_Fillable.pdf

2023 ATP Contractor Vendor Enrollment Guide Medicaid Forms.pdf