NEBRASKA MEDICAID PROGRAM

Nebraska Medicaid Program

Provider Information

Nursing Facility Provider Handbook

Process for a nursing facility to notify DHHS Caseworkers or Call Center staff of changes.

Prior Authorization Elimination/MDS Assessement Question and Answers

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 12	Nursing Facility Services
Chapter 36	Hospice Services

Appendices (Forms, Reports and Instructions)

471-000-2	Form DM-5, “Physician’s Confidential Report” and Completion Instructions
471-000-28	Instructions for Completing Form ASD-100, “De-Institutionalization Referral”
471-000-41	Instructions for Completing Form FA-66, “Long Term Care Cost Report”
471-000-43	Instructions for Completing Form MC-75, “MDS 2.0”
471-000-44	Instructions for Completing Form MC-75Q, “MDS 2.0 Quarterly Review”
471-000-45	Instructions for Completing Form MC-75-7, “MDS 2.0 Section S”
471-000-46	Instructions for Completing Form MC-75R, “MDS 2.0 Re-entry Tracking Form”
471-000-47	Instructions for Completing Form MC-75D, “MDS 2.0 Discharge Tracking Form”
471-000-48	Instructions for Completing Form MC-75PS, “MDS 2.0 Resident Assessment Protocol Summary Form”
471-000-49	Claims Submission Table
471-000-50	Standard Electronic Transaction Instructions
471-000-68	Form IM-8, “Notice of Finding”, and Completion Instructions
471-000-70	Nebraska Medicaid Billing Instructions for Medicare Crossover Claims
471-000-79	Form EA-160, “Record of Health Cost-Share of Cost-Medicaid Program” and Completion Instructions
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”
471-000-99	Medicaid Claim Adjustment and Refund Procedures
471-000-100	Form MCP575, “Casualty Insurance Policy Information Sheet”
471-000-104	Instructions for Completing Form MC-81, “Medical Assistance Long Term Care Provider Agreement”
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)
471-000-203	Instructions for Completing Form MC-9NF, “Prior Authorization for Nursing Facility Care”
471-000-211	Form MC-10, “Prior Authorization Document Adjustment”, and Completion Instructions
471-000-220	Instructions for Completing Form DSS-14AD, “Functional Criteria”
471-000-221	Instructions for Completing Form DM-5, “Physician’s Confidential Report,” for the Preadmission Screening Process (PASP)
471-000-222	Instructions for Completing Form DM-5-LTC, “Long Term Care Evaluation” for the Preadmission Screening Process (PASP)
471-000-224	Instructions for Completing Form DPI-OBRA2, “Evaluation and Service Recommendation”
471-000-225	Instructions for Completing Form DPI-OBRA2 MR/RC, “Evaluation and Service Recommendation” – MR/RC
471-000-227	Instructions for Completing Form DPI-OBRA5, “Notice of PASARRP Findings”
471-000-228	Instructions for Completing Form DPI-OBRA6, “Assurances”
471-000-229	Instructions for Completing Form DPI-OBRA7, “Referral for Community-Based Services”
471-000-230	Instructions for Completing Form DPI-OBRA8, “Authorization for Release of Information”
471-000-231	Instructions for Completing Form DPI-OBRA-9, “PASARRP Summary of Findings Report”
471-000-233	Qualified Mental Retardation Professional (42 CFR 483.430)
471-000-234	Guidelines for Social History

Provider Bulletins

Number	Subject	Date
13-27	Nebraska Medicaid Minimum Data Set (MDS) Requirements	03/22/13
13-26	Revised implementation date for the Elimination of Prior Authorization Process for Nursing Facility Services	03/19/13
12-09	Initial ICD-10 Awareness	02/07/12
12-05	2012 Medicaid Swing Bed Per Diem Rate	01/06/12
12-01	January 1 through December 31, 2012 Level 101, 102, 103 and 104 Rates	01/06/12
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
11-02	Change in MC-10 Process for Nursing Facilities (revises Provider Bulletin 10-41)	01/03/11
10-64	January 1 through December 31, 2011 Level 101, 102, 103 and 104 Rates	12/20/10
10-50	Nebraska Medicaid MDS 3.0 Requirements	09/22/10
10-42	MDS Section Q Referral Process	09/02/10
10-41	Change in MC-10 Process for Nursing Facilities	08/24/10
10-39	Nebraska Medicaid Implementation of the National Correct Coding Initiative Edits	09/20/10
10-23	RUG Change FAQ's	04/23/10
10-21	Medicaid Payment of Medicare Part A Nursing Facility Crossover Claims	06/17/10
10-20	RUG-III Grouper Upgrade-Related Changes: MDS Assessment Effective Dates	06/17/10
10-09	Nebraska Medicaid Casemix MDS RUG-III Grouper Upgrade	03/18/10
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
08-25	Revision to NAC 471 Appendix 471-000-82 Instructions for Completing Turnaround MC-4 "Long Term Care Facility Turnaround Billing Document"	06/25/08
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
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
07-07	Clarification of Facility Obligation to Reimburse for Nurse Aide Training and Competency Evaluation Program (NATCEP) Costs	02/26/07
05-08	Reimbursement for Wheelchairs Provided to Clients Residing in Nursing Facilities (Bulletin to DME Suppliers) (Rescind effective 05/01/08)	05/22/05
05-01	2005 revisions to Long Term Care Facility Turnaround/Add-on billing document (mc-4) Format and completion instructions	01/14/05

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