Nebraska Medicaid Program

Provider Information

Hospice 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 36 Hospice Services

PDF Appendices (Forms, Reports and Instructions)

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
471-000-78 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
471-000-81 Nebraska Medicaid Billing Instructions for Hospice Services
471-000-82 Instructions for Completing Turnaround MC-4, “Long Term Care Facility Turnaround Billing Document”
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"
471-000-123 Explanation of Nebraska Medicaid Eligibility Documents
471-000-124 Instructions for Using the Nebraska Medicaid Eligibility System (NMES)
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)
471-000-129 Explanation of Deleted Medicaid Claims and Medicaid Claims In Process over 30 Days Report (MCP564-DS)
471-000-536 Hospice Fee Schedule

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
11-65

FFY2012 Hospice Rates

9/21/11
11-56

Update on Turnaround Billing

09/15/11
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
11-02

Change in MC-10 Process for Nursing Facilities (revises Provider Bulletin 10-41)

01/03/10
10-64

January 1 through December 31, 2011 Level 101, 102, 103 and 104 Rates

12/20/10
10-49

Medicaid Hospice Payment Rates

09/17/10
10-39

Nebraska Medicaid Implementation of the National Correct Coding Initiative Edits

09/20/10
09-42

January 1 through December 31, 2010 Level 35 & 36 Rates

12/29/09
09-02

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

02/04/09
08-42

Nursing Facility, Hospice Level 35 & 36 Rates January 1 through December 31, 2009

01/06/09
08-34

Medicaid Hospice Payment Rates

10/01/08
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
07-25

Correction to Hospice Payment Rates and Wage Index

10/02/07
07-21

Hospice Payment Rates and Wage Index

09/12/07
07-20

Tamper-Resistant Prescription Pads for the Nebraska Medicaid (Rescind effective 03/14/08)

09/05/07
07-19

Change in Prior Authorization Process

09/04/07
07-14

Hospice Prior Authorizations

6/14/07
07-10

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

05/09/07
05-04

Hospice Prior Authorization Request and Updates

02/15/05

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

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