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.

Medicaid EDI Help Desk

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

 

 

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