Nebraska Medicaid Program

Provider Information

Durable Medical Equipment, Medical Supplies, Orthotics and Prosthetics 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.

PDF Regulations

Chapter 1 Administration
Chapter 2 Provider Participation
Chapter 3 Payment for Medical Services
Chapter 7 Durable Medical Equipment and Medical Supplies

PDF Appendices (Forms, Reports and Instructions)

471-000-49 Claims Submission Table
471-000-50 Standard Electronic Transaction Instructions
471-000-55 Billing Instructions for Durable Medical Equipment, Medical Supplies, Orthotics and Prosthetics
471-000-58 Example of Form CMS-1500, "Health Insurance Claim Form" (formerly HCFA-1500)
471-000-70 Nebraska Medicaid Billing Instructions for Medicare Crossover Claims
471-000-79 Form EA-160, "Record of Health Cost - Share of Cost - Medicaid Program", and Completion Instructions
470-000-80 ​Nebraska Medicaid Long-Term Care UB-04 Billing Instructions for Durable Medical Equipment (DME) submitted by Nursing Facilities (NF’s) NFs and Intermediate Care Facilities (ICFs )
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)
471-000-206 Form MS-77, "Request for Prior Authorization," and Completion Instructions
471-000-207 Instructions for Completing Form MS-78, "Augmentative Communication Device Selection Report"
471-000-208 Form MS-79, "Wheelchairs and Wheelchair Seating System Equipment Selection Report," and Completion Instructions
471-000-209 Form MS-80, "Air Fluidized and Low Air Loss Bed Certification of Medical Necessity," and Completion Instructions
471-000-507 Nebraska Medicaid Practitioner Fee Schedule for Durable Medical Equipment, Medical Supplies, Orthotics and Prosthetics

PDF Provider Bulletins

Number Subject Date
​14-12 ​Billing Instructions Updated – CMS 1500 and CMS 1450 (UB04) ​03/05/14
​13-50 Timely Filing Requirement for all Medicaid Claims ​07/15/13
​13-45 Breast Pump Policy Update ​08/05/13
​13-34 ​Durable Medical Equipment in Nursing and Intermediate Care Facilities ​05/15/13
​12-09 Initial ICD-10 Awareness ​02/07/12
​12-02 Reusable Protective Underpads: T-4537 NU, T-4540 ​01/04/12
11-47

Billing for Durable Medical Equipment & Supplies with the National Correct Coding Initiative

08/30/11
11-13

UPDATE Nebraska Medicaid Implementation of the National Correct Coding Initiative Edits

02/11/11
10-57

Change in Prior Authorization for DME Repairs

11/1/10
10-55

Breast Pump Policy Update

10/14/10
10-45

DME Fee Schedule Incontinence Product Changes Effective October 1, 2010

09/07/10
10-44

DME Fee Schedule Changes/Clarifications Effective October 1, 2010

08/31/10
10-39

Nebraska Medicaid Implementation of the National Correct Coding Initiative Edits

09/20/10
10-17

Change in Prior Authorization for DME Repairs

04/09/10
09-02

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

02/04/09
08-23

Durable Medical Equipment (DME) Fee Schedule Rate Changes

07/01/08
08-14

Reimbursement for Wheelchairs Provided to Clients Residing in Nursing Facilities (Bulletin to DME Suppliers)

05/01/08
08-12

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

05/12/08
08-07

Fee Schedule Rate Changes for Oxygen Services

03/10/08
07-10

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

05/09/07
06-24

Nutritional Supplementation

09/15/06
05-24

Nutritional Supplement Claim Submission and Reimbursement

09/14/05
05-07

Reimbursement for Wheelchairs Provided to Clients Residing in Nursing Facilities (Bulletin to DME Suppliers) (Rescind effective 05/01/08)

05/22/05

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


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