Nebraska Medicaid Program

Provider Information

Ambulatory Surgical Center Provider Handbook

The links below comprise your Nebraska Medicaid Provider Handbook. This handbook is your primary resource for information about the Nebraska Medicaid Program, including program regulations, service coverage requirements and limitations, forms, billing requirements, and payment information.

Please review this handbook prior to providing services and requesting payment from Nebraska Medicaid and share it with personnel who perform referrals, authorization, coding and claims submission for your office.

If you have questions or comments about this information, contact the Medicaid Program Specialist for the type of service: PDFContacts Medicaid.

PDF Regulations

Chapter 1 Administration
Chapter 2 Provider Participation
Chapter 3 Payment for Medical Services
Chapter 26 Ambulatory Surgical Center (ASC) Services

PDF Appendices (Forms, Reports and Instructions)

471-000-49 Claims Submission Table
471-000-50 Standard Electronic Transaction Instructions
471-000-52 Billing Instructions for Ambulatory Surgical Center (ASC) Services
471-000-58 Example of Form CMS-1500, "Health Insurance Claim Form" (formerly HCFA-1500)
471-000-62 Billing Instructions for Physician, Laboratory, and Ambulatory Surgical Center (ASC) Services
471-000-70 Billing Instructions for Medicare Crossover Claims
471-000-79 Form EA-160, "Record of Health Cost - Share of Cost - Medicaid Program", and Completion Instructions
471-000-85 Explanation of Remittance Advice and Refund Requests Report
471-000-87 Example of Form MC-2, "Electronic Attachment Control Number Form"
471-000-90 Form MC-19, "Medical Assistance Provider Agreement" and Completion Instructions
471-000-99 Medicaid Claim Adjustment and Refund Procedures
471-000-100 Form MCP575, "Casualty Insurance Policy Information Sheet"
471-000-122 Nebraska Health Connection: Listing of Plans and Vendors
471-000-123 Explanation of Nebraska Medicaid Eligibility Documents
471-000-124 Instructions for Using the Nebraska Medicaid Eligibility System (NMES)
471-000-127 Explanation of Deleted Medicaid Claims Weekly Report (MCP564-D)
471-000-128 Explanation of Medicaid Claims in Process Over 30 Days Report (MCP564-S)
471-000-409 State-Defined Ambulatory Surgical Center (ASC) Procedures

PDF Provider Bulletins

Number Subject Date
​14-12 Billing Instructions Updated – CMS 1500 and CMS 1450 (UB04) ​03/05/14
​14-04 Immediate enrollment into Managed Care ​01/14/14
​13-82 ​​Medicaid ICD-10 Implementation Project December 2013 Update ​12/20/13
​13-80 ​​Preferred Drug List (PDL) Changes ​12/12/13
​13-75 Implementation of Revised CMS 1500 Claim Form / Version 02/12 ​11/14/13
​13-68 New National Correct Coding Initiative (NCCI) Edits Regarding Evaluation-and-Management Services on the Day of Surgery, Effective October 2013 ​10/08/13
​13-63 ​​Medicaid Drug Rebate Program - National Drug Code (NDC) Reporting Requirement for Physician Administered Drugs New Quantity Limits ​09/05/13
​13-50 Timely Filing Requirement for all Medicaid Claims ​07/15/13
​12-09 ​Initial ICD-10 Awareness ​02/07/12

UPDATE Nebraska Medicaid Implementation of the National Correct Coding Initiative Edits


Nebraska Medicaid Implementation of the National Correct Coding Initiative Edits


Provider responsibility to screen employees and contractors for HHS-OIG exclusion status


Ambulatory Surgery Center Rates Effective:  July 1, 2008


DHHS Website Email Notification Feature, Online Provider Handbooks and Provider Bulletins, Electronic Claims, Funds Transfer and Other Options


Tamper-Resistant Prescription Pads for the Nebraska Medicaid Pharmacy Program (Revised)


Tamper-Resistant Prescription Pads for the Nebraska Medicaid (Rescind effective 03/14/08)


New Medicaid Claim Reports – New Process for Reporting Deleted Medicaid Claims


Ambulatory Surgery Center Rates Effective: January 1, 2007


Go to Rules and Regulations and Provider Bulletins for all Medicaid regulations, appendices and bulletins.

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