Nebraska Medicaid Program

Electronic Data Interchange (EDI)

5010 Trading Partner Enrollment Forms

The following forms are required for Providers and/or Trading Partners to exchange data electronically with Nebraska Medicaid

 All Trading Partners will be required to enroll and pass the testing process prior to exchanging 5010 Transactions.


Complete and mail the original, signed copy of the Trading Partner Agreement to:

Department of Health and Human Services
ATTN: Medicaid EDI Help Desk
P.O. Box 95026
Lincoln, NE 68509-5026

The Trading Partner Profile and Trading Partner Authorization forms can be Emailed or faxed after completion. Fax (402-742-2353) Email


If you are an enrolled trading partner, but would like to add a new transaction, complete a new Nebraska Medicaid Trading Partner Profile. Fax (402-742-2353), Email or mail the completed form to the address listed above. Contact the EDI Help Desk to begin EDI Testing.

To begin or discontinue submitting transactions for a provider, complete a Nebraska Medicaid Trading Partner Authorization.

Medicaid EDI Help Desk

866-498-4357 (toll free) or 471-9461 (in Lincoln)



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