NEBRASKA MEDICAID PROGRAM

Nebraska Medicaid Program

Provider Information

Home Health 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.

Regulations

Table of Contents

Chapter 1	Administration
Chapter 2	Provider Participation
Chapter 3	Payment for Medical Services
Chapter 7	Durable Medical Equipment and Medical Supplies
Chapter 9	Home Health Agencies

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)
471-000-57	Billing Instructions for Home Health Agency Services
471-000-70	Nebraska Medicaid Billing Instructions for Medicare Crossover Claims
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"
471-000-121	Explanation of Form PDS-38B, "Nebraska Health Connection ID Document"
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)
471-000-129	Explanation of Deleted Medicaid Claims and Medicaid Claims In Process over 30 Days Report (MCP564-DS)
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
471-000-509	Nebraska Medicaid Home Health Agency Fee Schedule

Provider Bulletins

Number	Subject	Date
12-09	Initial ICD-10 Awareness	02/07/12
12-06	NEW Streamlined Review Process for Home Health Agencies Beginning February 15, 2012	01/30/12
11-28	FY2012 Nebraska Medicaid Fee Schedule for Home Health Services	06/15/11
11-13	UPDATE Nebraska Medicaid Implementation of the National Correct Coding Initiative Edits	02/11/11
11-12	Compliance with Medicaid Home Health and PDN Rules	02/07/11
10-39	Nebraska Medicaid Implementation of the National Correct Coding Initiative Edits	09/20/10
10-35	Authorization of HH & PDN Services	08/09/10
10-29	FY 2011 Nebraska Medicaid Fee Schedule for Home Health Services	07/01/10
10-11	Change in Authorization Process for Home Health Postpartum/”Well Baby” Visits	04/1/10
10-06	Change in Medicaid Utilization Control and Quality Management Review Services	02/25/10
09-37	FY2010 Fee Schedule Information	09/30/09
09-19	FY2010 Nebraska Medicaid Fee Schedule for Home Health Agency Services (Appendix 471-000-509)	08/11/09
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
08-12	DHHS Website Email Notification Feature, Online Provider Handbooks and Provider Bulletins, Electronic Claims, Funds Transfer and Other Options	05/12/08
08-11	Changes in the Home Health Agency Prior Authorization Process	04/18/08
08-07	Fee Schedule Rate Changes for Oxygen Services	03/10/08
07-26	2007/2008 Medicaid RSV Infection Prophlaxis Update	10/12/07
07-24	Influenza Vaccine - 2007/2008 Update	10/05/07
07-19	Change in Prior Authorization Process	09/04/07
07-13	Home Health Agency Prior Authorization Process Changes on June 5, 2007	06/01/07
07-10	New Medicaid Claim Reports – New Process for Reporting Deleted Medicaid Claims	05/09/07
05-07	Reimbursement for Wheelchairs Provided to Clients Residing in Nursing Facilities (Bulletin to DME Suppliers)	05/22/05
04-21	Risperdal Consta	10/21/04

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

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DHHS Internet Website - Medicaid & Long-term Health Care