Become An Ambetter Provider in Nebraska | Ambetter from Nebraska Total Care

 

Join Our Network

Thank you for your interest in participating in the Ambetter from Nebraska Total Care network!  If you would like to receive more information on becoming a provider within our network, please complete the form below.

Required fields are marked with an asterisk (*)

Please download and fill out the IRS W-9 Form.

  

Disclaimer: This form will send your message to Ambetter from Nebraska Total Care as an email. The email is not encrypted and is not transmitted in a secured format. By communicating with Ambetter from Nebraska Total Care through email, you accept associated risks. Ambetter from Nebraska Total Care does not accept responsibility or liability for any loss or damage arising from the use of email. To ensure the safety of your PHI, please send us a message through the Secure Member or Provider portal.

Agreement*
Agreement*