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: PDFContacts Medicaid.

PDF Regulations

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

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)
471-000-57 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"
471-000-122 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

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
​13-62 Discontinuation of Home Health Type of Bill 33X ​09/03/13
13-50 Timely Filing Requirement for all Medicaid Claims ​07/15/13
​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
10-29

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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