Nebraska Medicaid Program
Personal Assistance Services 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.
Appendices (Forms, Reports and Instructions)
||Instructions for Completion of Form HHS-5N, “N-FOCUS Health and Human Services Billing Document” |
||Appendix 471-000-74 Instructions for Completing Form MC-39|
||Instructions for Completing Form MC-84, “Personal Assistance Provider Check List”|
||“Service Needs Assessment/Plan”|
||Instructions for Completing Form MILTC-9, "Service Provider Agreement"|
||Instructions for Completing Form MILTC-4D. "Physician/RN Statement for Health Maintenance Activities"|
||“Provider Authorization Update”|
||Instructions for Completing Form IRS-2678, "Employer Appointment of Agent"|
||Explanation of Nebraska Medicaid Eligibility Documents|
||Nebraska Medicaid Personal Assistance Services Rate Listing|
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.