NEBRASKA MEDICAID PROGRAM

Nebraska Medicaid Program

Provider Information

Mental Health and Substance Abuse
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 20	Psychiatric Services for Individuals Age 21 and Older
Chapter 32	Mental Health and Substance Abuse Treatment Services for Children and Adolescents
Chapter 35	Rehabilitative Psychiatric Services

Appendices (Forms, Reports and Instructions)

471-000-7	Example of Form DM-8, “IPR-Institutions for Mental Disease Ages 21 and Under”
471-000-8	Example of Form DM-9, “IPR-Institutions for Mental Disease Ages 65 and Older”
471-000-10	Instructions for Completing “Nebraska Medicaid Telehealth Patient Consent” Form
471-000-40	Form FA-20, “Cost Report of Psychiatric and Chemical Dependency Facilities for Medicaid Reimbursement”, and Completion 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)
471-000-58	Example of Form CMS-1500, “Health Insurance Claim Form” (formerly HCFA-1500)
471-000-64	Billing Instructions for Mental Health and Substance Abuse 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”
471-000-89	Form MC-14, “Confidential Report”, and Completion Instructions
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”
471-000-102	Form MC-9, “Prior Authorization Document,” and Completion Instructions for IMD’s
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)
471-000-127	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)
471-000-211	Form MC-10, “Prior Authorization Document Adjustment”, and Completion Instructions
471-000-532	Nebraska Medicaid Practitioner Fee Schedule for Mental Health and Substance Abuse Services
471-000-540	Nebraska Medicaid Practitioner Fee Schedule for Injectables

Provider Bulletins

Number	Subject	Date
12-09	Initial ICD-10 Awareness	02/07/12
11-23	Claims for MHSA Services & the National Correct Coding Initiative	06/17/11
11-13	UPDATE Nebraska Medicaid Implementation of the National Correct Coding Initiative Edits	02/11/11
11-05	Community Support Implementation Delay	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
10-39	Nebraska Medicaid Implementation of the National Correct Coding Initiative Edits	09/20/10
10-26	Secure Residential Rehabilitation Services	07/01/10
10-22	July 1, 2010 Rate Increase	06/25/10
09-11	Update of Medicaid Managed Care Outpatient Utilization Review Processes	04/06/09
09-05	Improved Medicaid Managed Care Outpatient Utilization Review	02/27/09
09-02	Provider responsibility to screen employees and contractors for HHS-OIG exclusion status	02/04/09
08-38	Regulations for Assertive community Treatment (ACT) Services	11/20/08
08-36	Licensed Independent Mental Health Practitioners (LMHPs)	10/09/08
08-26	Mental Health Substance Abuse (MHSA) July 1, 2008 Fee Schedule Changes	06/27/08
08-12	DHHS Website Email Notification Feature, Online Provider Handbooks and Provider Bulletins, Electronic Claims, Funds Transfer and Other Options	05/12/08
08-10	Managed Care Rate Increase	04/01/08
08-06	Tamper-Resistant Presciption Pads for the Nebraska Medicaid Pharmacy Program (Revised)	03/14/08
08-03	National Drug Code (NDC) Requirements for Physician Administered Medication	01/31/08
07-29	Procedure Code Change for the Annual Assessment by Psychologists	04/01/08
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
07-03	Crisis Services	01/24/07
06-17	Documentation for Mental Health and Substance Abuse Services	08/04/06
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