Nebraska Medicaid Program

Provider Information

Federally Qualified Health 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 29 Federally Qualified Health Centers (FQHC’s)

PDF Appendices (Forms, Reports and Instructions)

471-000-10 Instructions for Completing “Nebraska Medicaid Telehealth Patient Consent” Form
471-000-49 Claims Submission Table
471-000-50 Standard Electronic Transaction Instructions
471-000-51 Form CMS-1450 (UB-92), “Health Insurance Claim Form”, (Formerly HCFA-1450)
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 Nebraska Medicaid Billing Instructions for Medicare Crossover Claims
471-000-76 Billing Instructions for Federally Qualified Health Center Services
471-000-78 Nebraska Medicaid Form Locator Requirements for Form CMS-1450 (UB-92)
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)
471-000-129 Explanation of Deleted Medicaid Claims and Medicaid Claims In Process over 30 Days Report (MCP564-DS)

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
​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
09-02

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

02/04/09
08-12

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

05/12/08
08-06

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

03/14/08
07-20

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

09/05/07
07-10

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

05/09/07
06-27

Revenue Code Place of Service Billing Change

12/20/06
03-11

Use of National HCPCS/CPT Procedure Codes and Modifiers for EPSDT Encounters

09/15/03

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

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