Home Health Provider Handbook

 
2
Medicaid Related Assistance
Medicaid & Long-Term Care
 
No
No

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What you need to know

​​This handbook is your primary resource on the Nebraska Medicaid program, including program regulations and service coverage requirements, as well as limitations, forms, billing requirements, and payment information.

Please review this handbook before providing services and requesting payment from Nebraska Medicaid, and share the handbook with personnel who perform referrals, authorization, coding, and claims submission for your office.

If you have questions or comments about this information, contact the Medicaid program specialist for this service type: Medicaid Contacts

Regulations
Table of Contents
Chapter 1 Administration
Chapter 2 Provider Participation
Chapter 3 Payment for Medical Services
Chapter 7 Durable Medical Equipment and Medical Supplies
​Chapter 9​Home Health Agencies


 

Appendices (Forms, Reports and Instructions)
​471-000-10​Instructions for Completing “Nebraska Medicaid Telehealth Patient Consent" Form
471-000-49 Claims Submission Table
471-000-50 Standard Electronic Transaction Instructions
​471-000-51​Form CMS-1450 (UB-92), “Health Insurance Claim Form", (Formerly HCFA-1450)
​471-000-57​Billing Instructions for Home Health Agency Services
471-000-70 Nebraska Medicaid Billing Instructions for Medicare Crossover Claims
​471-000-78​Nebraska Medicaid Form Locator Requirements for Form CMS-1450 (UB-92)
471-000-79 Form EA-160, "Record of Health Cost-Share of Cost-Medicaid Program" and Completion Instructions
471-000-85 Explanation of Remittance Advice and Refund Requests Report
471-000-87 Example of Form MC-2, "Electronic Attachment Control Number Form"
471-000-90 Form MC-19, "Medical Assistance Provider Agreement" and Completion Instructions
471-000-99 Medicaid Claim Adjustment and Refund Procedures
471-000-100 Form MCP575, "Casualty Insurance Policy Information Sheet"
471-000-122 Nebraska Health Connection: Listing of Plans and Vendors
471-000-123 Explanation of Nebraska Medicaid Eligibility Documents
471-000-124 Instructions for Using the Nebraska Medicaid Eligibility System (NMES)
​471-000-129

​Explanation of Deleted Medicaid Claims and Medicaid Claims In Process over 30 Days Report (MCP564-DS)

471-000-206 Form MS-77, "Request for Prior Authorization," and Completion Instructions
471-000-207 Instructions for Completing Form MS-78, "Augmentative Communication Device Selection Report"
471-000-208

Form MS-79, "Wheelchairs and Wheelchair Seating System Equipment Selection Report," and Completion Instructions

471-000-209

Form MS-80, "Air Fluidized and Low Air Loss Bed Certification of Medical Necessity,"and Completion Instructions