NEBRASKA MEDICAID PROGRAM

Nebraska Medicaid Program

Provider Information

Hospital Provider Handbook

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: Contacts Medicaid.

Regulations

Table of Contents

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

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, “Serilization Consent Form”, and Completion Instructions
471-000-110	Form MMS-101, “Informed Consent for Hysterectomies”, and Completion Instructions
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)
471-000-126	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

Provider Bulletins

Number	Subject	Date
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 Presciption 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 Otpatient 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 format require the use of Adobe Acrobat Reader which can be dowloaded for free from Adobe Systems, Inc.

DHHS Internet Website - Medicaid & Long-term Health Care