PicturesAgingMedicaid Waiver InitiativePress ReleasesSearch NEBRASKA MEDICAID PROGRAM Page Content Medicaid Program Home Medicaid Services Medicaid Reform Medical Assistance Advisory Committee Current Initiatives Contacts Medicaid Electronic Health Record (EHR) Incentive Program Medical Necessity Guideline and Criteria Provider Information Program Integrity CHIP Managed Care Pharmacy Services Rules and Regulations Medicaid State Plan Electronic Data Interchange Client Information Recent Web Updates Nebraska Medicaid Program Provider Information Dental 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: Contacts Medicaid. http://datawarehouse.hrsa.gov/IKN/WidgetSearch.aspx Regulations Table of Contents Chapter 1 Administration Chapter 2 Provider Participation Chapter 3 Payment for Medical Services Chapter 6 Dental Services Appendices (Forms, Reports and Instructions) 471-000-10 Instructions for Completing "Nebraska Medicaid Telehealth Patient Consent" Form 471-000-39 Dental Periodicity Schedule for Children 471-000-49 Claims Submission Table 471-000-50 Standard Electronic Transaction Instructions 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" 471-000-88 Instructions for Completing 2012 ADA Dental Claim 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) 471-000-126 Procedure Codes Subject to Copayment Requirements 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) 471-000-406 Orthodontic Diagnostic Score Sheet and Other Information Provider Bulletins Number Subject Date 17-16 Dental Managed Care Program; Contract Awarded 06/13/17 17-14 Dental Managed Care Program; Start Date Update 04/13/17 16-29 Dental Managed Care Program 12/07/16 15-36 ICD-10 and Dental Claims 09/17/15 15-13 Dental Hygienists and Procedure Codes 04/06/15 15-11 Suspension of Dental Carve In 04/03/15 14-12 Billing Instructions Updated – CMS 1500 and CMS 1450 (UB04) 03/05/14 13-82 Medicaid ICD-10 Implementation Project December 2013 Update 12/20/13 13-51 Affordable Care Act Administrative Simplification (AS) Requirements for HIPAA Electronic Transactions: Eligibility for a Health Plan (270/271) and Health Care Claim Status (276/277) 07/19/13 13-50 Timely Filing Requirement for all Medicaid Claims 07/15/13 13-47 American Dental Association (ADA) Claim Form 2012 07/18/13 13-33 Prior authorization for root canals 06/06/13 12-62 New Dental Procedure Code 12/06/12 12-52 Provider Screening and Enrollment 10/12/12 12-09 Initial ICD-10 Awareness 02/07/12 11-13 UPDATE Nebraska Medicaid Implementation of the National Correct Coding Initiative Edits 02/11/11 10-39 Nebraska Medicaid Implementation of the National Correct Coding Initiative Edits 09/20/10 09-07 Adult Dental Emergencies 04/01/09 09-02 Provider responsibility to screen employees and contractors for HHS-OIG exclusion status 02/04/09 08-18 $1000 Annual Dental Benefit Limit for Adults 06/30/08 Go to Rules and Regulations and Provider Bulletins for all Medicaid regulations, appendices and bulletins. Documents in PDF format require the use of Adobe Acrobat Reader which can be downloaded for free from Adobe Systems, Inc.