Nebraska Medicaid Program

Electronic Data Interchange (EDI)

EDI Frequently Asked Questions

Here are some frequently asked questions and answers about Electronic Data Interchange with Nebraska Medicaid. If you don’t find your questions and answers here, call the Medicaid EDI Help Desk.

Can I send claims that require attachments electronically?
What other information can I send or receive electronically?
Do you furnish software for submitting claims electronically?
Can you recommend a clearinghouse?
What questions should I ask when searching for a clearinghouse?
Can I submit my claims electronically without using a clearinghouse?
What is involved in the testing process?
How do I get started?
What are your requirements for NPI?
Do you support SFTP (Secure File Transfer Protocol) for submission of X12 HIPAA electronic transactions?
Do you support HTTPS for submission of X12 HIPAA electronic transactions?
What is the 277 Claims Acknowledgment?
What information is available on the 277 Claims Acknowledgment?
Where can I find Sample Electronic Claim Activity Reports?
When can an electronic claim be voided?


Can I send claims that require attachments electronically?

Yes. Claims that require paper attachments, such as invoices or consent forms, can be sent electronically. The claim must contain an attachment control number. The attachment is then mailed or faxed, along with a form identifying it as a claim attachment. Click here 471-000-87 for the form (MC-2) and instructions.

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What other information can I send or receive electronically?

The electronic Remittance Advice, Claim Status, and Eligibility Inquiry transactions are the most common. We support all the HIPAA-mandated electronic transactions for healthcare payers.

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Do you furnish software for submitting claims electronically?

No, we do not furnish software. Most providers use a clearinghouse to submit their claims.

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Can you recommend a clearinghouse?

Nebraska Medicaid is unable to recommend any particular clearinghouse.  However, available in our FAQ section, we do have a list of recommended questions to ask any potential clearinghouse.

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What questions should I ask when searching for a clearinghouse?

  • Are you currently submitting electronic claims to Nebraska Medicaid?
  • Do you submit claims directly to Medicaid or do you transmit to another party?
  • How soon after you receive our claims are they transmitted?
  • How will we know if our claims were successfully received?
  • What if our claims encounter errors after they reach Nebraska Medicaid, how will we be notified of this and when?
  • What are the names of some other Nebraska Medicaid Providers that submit claims through your company?

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Can I submit my claims electronically without using a clearinghouse?

Yes, if you have the technical expertise to create the transaction in the ASC X12N format and meet the X12 claim submission requirements.

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What is involved in the testing process?

You will work closely with the Medicaid EDI Help Desk during testing. For more information, see EDI Testing Process and Requirements.

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How do I get started?

If you plan to use a clearinghouse, research the options. After selection, the clearinghouse will take care of the paperwork required to add you as a trading partner.

If you plan to submit your claims directly to Nebraska Medicaid, complete the EDI Enrollment Forms and have your technical programmer contact the Medicaid EDI Help Desk.

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What are your requirements for NPI?

Effective January 1, 2012, NPI, taxonomy code and zip + 4 (9 digit zip code) must be submitted for billing providers and NPIs are expected for all other provider identifiers. Atypical providers may continue to use legacy Medicaid Provider numbers.

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Do you support SFTP (Secure File Transfer Protocol) for submission of X12 HIPAA electronic transactions?

Yes, effective December 15, 2010, Nebraska Medicaid began supporting SFTP (Secure File Transfer Protocol) for submission of X12 HIPAA electronic transactions. The X12 Submission Requirements Manual using Secure File Transfer Protocol (SFTP) Version 2.0 is available on our website.

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Do you support HTTPS for submission of X12 HIPAA electronic transactions?

Effective March 9, 2015, Nebraska Medicaid will begin to accept 270 and 276 transactions via HTTPS.  As it is available, further information regarding these transactions will be posted at: http://dhhs.ne.gov/medicaid/Pages/AS-ECS.aspx.

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What is the 277 Claims Acknowledgment?

The HIPAA 5010 277 Claims Acknowledgment Transaction is an acknowledgment of receipt of claim submission(s) at the pre-processing stage; which is the process that determines whether or not to introduce the claim into the MMIS adjudication system. Claims will be reported back to the Trading Partner as either ‘accepted’ or ‘rejected’.

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What information is available on the 277 Claims Acknowledgment?

The 277 Claims Acknowledgment Transaction may report at the Information Receiver Level, Provider Level, Claim Level and Line level, providing the following information:

  • Reports total claims accepted and total claims rejected.
  • Reports total accepted billed amounts and total rejected billed amounts.
  • Claims that have been accepted are reported with the assigned MMIS claim number.
  • Claims that have been rejected are reported with a HIPAA X12 Claim Status Category Code and Claim Status Code(s). Up to 3 may be reported for a claim.
  • Service line information is included when a service line causes the rejection of a claim.

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Where can I find Sample Electronic Claim Activity Reports?

Sample Electronic Claim Activity (ECA) Reports are available online and can be found here: http://dhhs.ne.gov/medicaid/Pages/med_edirep-5010.aspx.

  • Nebraska Medicaid uses national codes for reporting on the Electronic Claim Activity Reports. Click here Washington Publishing Company (WPC) HIPAA Code List to connect to the web site where national codes are maintained.
    • Medicaid Deleted Claims and Medicaid Electronic Claim Activity (ECA) reports use: “Claim Status Codes” and “Claim Status Category Codes."

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When can an electronic claim be voided?

  • A claim can only be voided if it has yet to been processed.  A claim that has been rejected, deleted, paid, or denied cannot be voided.
  • If the claim has been rejected or deleted you must resubmit the claim.

If the claim has been paid in error or denied you must follow the outlined adjustment procedure.  More information on Nebraska Medicaid's adjustment procedure can be found in the 471 Appendix   471-000-99.

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Medicaid EDI Help Desk

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

 

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