Nebraska Medicaid Program

Provider Information

Hearing Aid 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 8 Hearing Aids

PDF Appendices (Forms, Reports and Instructions)

471-000-3 Form DM-5H, “Physician’s Report on Hearing Loss” and Completion Instructions
471-000-49 Claims Submission Table
471-000-50 Standard Electronic Transaction Instructions
471-000-56 Billing Instructions for Hearing Aid Services
471-000-58 Example of Form CMS-1500, "Health Insurance Claim Form" (formerly HCFA-1500)
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)
471-000-126 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)
471-000-205 Form MC-9HA, “Prior Authorization Document for Hearing Aids”, and Completion Instructions
471-000-508 Nebraska Medicaid Practitioner Fee Schedule for Hearing Aid Services

PDF Provider Bulletins

Number Subject Date
​14-14 Utilization Review Organization ​05/07/14
​14-12 Billing Instructions Updated – CMS 1500 and CMS 1450 (UB04) ​03/05/14
​14-03 National Correct Coding Initiative (NCCI) regarding conformity evaluations ​03/06/14
​13-50 Timely Filing Requirement for all Medicaid Claims ​07/15/13
​13-46 Copayments for Hearing Aids ​09/03/13
​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
10-47

Hearing Aid Fee Schedule Pricing Effective July 1, 2010

09/08/10
10-39

Nebraska Medicaid Implementation of the National Correct Coding Initiative Edits

09/20/10
09-12

Hearing Aids:   RP modifier obsolete - use RA or RB

04/01/09
09-02

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

02/04/09
08-24

Fee Schedule Update

06/26/08
08-21

Hearing Aid Policy Changes Effective July 1, 2008

06/26/08
08-12

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

05/12/08
07-10

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

05/09/07

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

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