Nebraska Medicaid Program

Provider Information

Medical Transportation 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: pdficon.gif (914 bytes)Contacts Medicaid.

pdficon.gif (914 bytes) Regulations

Chapter 1 Administration
Chapter 2 Provider Participation
Chapter 3 Payment for Medical Services
Chapter 27 Medical Transportation Services

pdficon.gif (914 bytes) Appendices (Forms, Reports and Instructions)

471-000-49 Claims Submission Table
471-000-50 Standard Electronic Transaction Instructions
471-000-80 Form MS-66, “Medicaid Mental Health Transporation Services Authorization and Claim Form”, and Completion Instructions
471-000-85 Explanation of Remittance Advice and Refund Requests Report
471-000-90 Form MC-19, “Medical Assistance Provider Agreement” and Completion Instructions
471-000-99 Medicaid Claim Adjustment and Refund Procedures
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)

pdficon.gif (914 bytes) Provider Bulletins

Number Subject Date
​14-12 Billing Instructions Updated – CMS 1500 and CMS 1450 (UB04) ​03/05/14
​14-04 ​​Immediate enrollment into Managed Care ​01/14/14
​13-73 Non-Emergency Ambulance Services ​11/05/13
​13-51 Affordable Care Act Administrative Simplification (AS) Requirements for HIPAA Electronic Transactions: Eligibility for a Health Plan (270/271) and Health Care Claim Status (276/277) ​07/19/13
​13-50 Timely Filing Requirement for all Medicaid Claims ​07/15/13
​12-28 Non-Emergency Transportation (NET) Services ​06/06/12
​12-19 Changes to non-emergency transportation services for Physical Health Managed Care ​04/23/12
​12-09 Initial ICD-10 Awareness ​02/07/12

Implementation of Non-Emergency Transportation (NET) Fee Schedule (Appendix 471-000-503)


UPDATE Nebraska Medicaid Implementation of the National Correct Coding Initiative Edits


Revised implementation date for the Transportation Brokerage


Changes in provider criminal history background check requirements


Changes in the administration of Non-Emergency Medical and Non-Medical Transportation


Nebraska Medicaid Implementation of the National Correct Coding Initiative Edits


LB 97 - National Background Checks with Fingerprints


Provider Responsibilities and Service Provider Agreements/Medical Assistance Provider Agreements


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


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


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


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

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