Nebraska Medicaid Program

Provider Information

Private Duty Nursing 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 13 Private-Duty Nursing Services

PDF Appendices (Forms, Reports and Instructions)

471-000-49 Claims Submission Table
471-000-50 Standard Electronic Transaction Instructions
471-000-59 Form MC-82N, “Private Duty Nurse Claim Form”, and Completion Instructions
471-000-67 Form MS-81, “Certification and Plan of Care for Private-Duty Nursing”, and Completion Instructions
471-000-69 Instructions for Completing Form MS-82, “Adult Day Care Assessment/Authorization”
471-000-70 Nebraska Medicaid Billing Instructions for Medicare Crossover Claims
471-000-75 Nebraska Medicaid Billing Instructions for Completing Form MC-82-AD, “Adult Day Care nursing/Aide Services Claim Form” for Private Duty Nursing or Personal Assistance Services in Adult Day Care Centers
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”
471-000-90 Form MC-19, “Medical Assistance Provider Agreement” and Completion Instructions
471-000-97 Instructions for Completing Form HHS-100 “Private Duty” Nursing Notes
471-000-99 Medicaid Claim Adjustment and Refund Procedures
471-000-100 Form MCP575, “Casualty Insurance Policy Information Sheet”
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)
471-000-513 Nebraska Medicaid RN/LPN Fee Schedule

PDF Provider Bulletins

Number Subject Date
​14-14 Utilization Review Organization ​05/07/14
​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
11-29

FY2012 Nebraska Medicaid Fee Schedule for Private Duty Nursing Services

06/15/11
11-13

UPDATE Nebraska Medicaid Implementation of the National Correct Coding Initiative Edits

02/11/11
10-39

Nebraska Medicaid Implementation of the National Correct Coding Initiative Edits

09/20/10
10-28

FY 2011 Nebraska Medicaid Fee Schedule for Private-Duty Nursing Services

07/01/10
10-06

Change in Medicaid Utilization Control and Quality Management Review Services

02/25/10
09-37

FY2010 Fee Schedule Information

09/30/09
09-20

FY2010 Nebraska Medicaid Fee Schedule for Private-Duty Nursing Services (Appendix 471-000-513)

08/11/09
09-02

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

02/04/09
08-24

Fee Schedule Update

06/26/08
08-12

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

05/12/08
07-10

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

05/09/07

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

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