Nebraska Medicaid Program

Provider Information

Hospital Provider Handbook

PDF How to Report A Birth of A Newborn User Guide

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 10 Hospital Services
Chapter 14 Occupational Therapy Services
Chapter 17 Physical Therapy Services
Chapter 20 Psychiatric Services for Individuals Age 21 and Older
Chapter 21 Rehabilitation Care in Hospitals
Chapter 22 Respiratory Therapy Services
Chapter 23 Speech Pathology and Audiology Services
Chapter 32 Mental Health and Substance Abuse Treatment Services for Children and Adolescents

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)
471-000-70 Nebraska Medicaid Billing Instructions for Medicare Crossover Claims
471-000-73 Form MS-6, “Ambulatory Room and Board Agreement”, and Completion Instructions
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
471-000-83 Billing Instructions for Hospital Services
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
471-000-91 Form MC-20, “Medicaid Hospital Provider Agreement”, and Completion Instructions
471-000-96 Form MC-83, “Mental Health/Substance Abuse Treatment Planning Document for Outpatient Services”, and Completion Instructions
471-000-99 Medicaid Claim Adjustment and Refund Procedures
471-000-100 Form MCP575, "Casualty Insurance Policy Information Sheet"
471-000-109 Form MMS-100, “Sterilization Consent Form”, and Completion Instructions
471-000-110 Form MMS-101, “Informed Consent for Hysterectomies”, and Completion Instructions
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
471-000-129 Explanation of Deleted Medicaid Claims and Medicaid Claims In Process over 30 Days Report (MCP564-DS)
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
471-000-532 Nebraska Medicaid Practitioner Fee Schedule for Mental Health and Substance Abuse Services

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

11-56

Update on Turnaround Billing 09/15/11

11-48

Room Charge Billing for Observation Room and Emergency Department Services 08/30/11

11-25

Elimination of Turnaround Billing Document

05/20/11

11-13

UPDATE Nebraska Medicaid Implementation of the National Correct Coding Initiative Edits

02/11/11

11-04

2011 Medicaid Swing Bed Per Diem

01/10/11

10-60

A. Coverage of Zyprexa Relprevv
B. Revised Risperdal Consta Authorization Requirements
C. End Prior Authorization of Certain Psychiatric Injectable Medications

12/15/10

10-46

Reporting Birth of Newborn on ACCESSNebraska web portal

10/12/10

10-39

Nebraska Medicaid Implementation of the National Correct Coding Initiative Edits

09/20/10

10-22

July 1, 2010 Rate Increase

06/25/10

10-03

2010 Medicaid Swing Bed Per Diem

02/10/10
09-28

Inpatient Hospital Prospective Payment System - Diagnosis Related Groups (DRG) Grouper

09/01/09
09-16

Radiology Prior Authorization(s)

04/21/09
09-11

Update of Medicaid Managed Care Outpatient Utilization Review Processes

04/06/09
09-03

CY2009 Medicaid Swing Bed Per Diem

03/05/09
09-02

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

02/04/09
08-29

National Drug Code Billing Requirements for Outpatient Hospital Setting

08/01/08
08-28

Outpatient Hospital/Facility Billing Instructions for Reporting National Drug Codes

07/24/08
08-26

Mental Health Substance Abuse (MHSA) July 1, 2008 Fee Schedule Changes

06/27/08
08-16

Billing Instructions for Outpatient Hospital/Facility Reporting of National Drug Codes (NDCs)

05/07/08
08-12

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

05/12/08
08-06

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

03/14/08
08-05

Hospital Billing Instructions for Claims with Share of Cost

02/28/08
08-02

National Drug Code (NDC) Submission for Physician Administered Drugs in an Outpatient Facility

01/09/08
07-32

Third Party Liability - Billing Medicaid when the Primary Insurance is Equal to or Greater than the Medicaid Allowable

12/20/07
07-26

2007/2008 Medicaid RSV Infection Prophlaxis Update

10/12/07
07-24

Influenza Vaccine - 2007/2008 Update

10/05/07
07-23

Peer Review Organization

10/09/07
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
04-21

Risperdal Consta

10/21/04

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

Documents in PDF PDF format require the use of Adobe Acrobat Reader which can be downloaded for free from Adobe Systems, Inc.