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.
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.
Documents in PDF format require the use of Adobe Acrobat Reader which can be downloaded for free from Adobe Systems, Inc.