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 electronically?
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?

Can I send claims electronically?

All claim types - professional, dental, and institutional - can be submitted electronically.

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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 PDF471-000-87 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?

We cannot recommend any particular clearinghouse, however, for a list of clearinghouses that currently exchange electronic data with Nebraska Medicaid, click here PDFEDI Trading Partners.

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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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Medicaid EDI Help Desk

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

 

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