Nebraska Medicaid Program
Electronic Data Interchange (EDI)
5010 Trading Partner Enrollment Forms
All Trading Partners will be required to enroll and pass the testing process prior to exchanging 5010 Transactions.
NEW TRADING PARTNERS:
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 DHHS.MedicaidEDI@nebraska.gov
CURRENT TRADING PARTNERS
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.
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