Nebraska Medicaid Program
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: Contacts Medicaid.
Appendices (Forms, Reports and Instructions)
||Claims Submission Table|
||Standard Electronic Transaction Instructions|
||Form MC-82N, “Private Duty Nurse Claim Form”, and Completion Instructions|
||Form MS-81, “Certification and Plan of Care for Private-Duty Nursing”, and Completion Instructions|
||Instructions for Completing Form MS-82, “Adult Day Care Assessment/Authorization”|
||Nebraska Medicaid Billing Instructions for Medicare Crossover Claims|
||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|
||Form EA-160, “Record of Health Cost-Share of Cost-Medicaid Program” and Completion Instructions|
||Explanation of Remittance Advice and Refund Requests Report|
||Example of Form MC-2, “Electronic Attachment Control Number Form”|
||Form MC-19, “Medical Assistance Provider Agreement” and Completion Instructions|
||Instructions for Completing Form HHS-100 “Private Duty” Nursing Notes|
||Medicaid Claim Adjustment and Refund Procedures|
||Form MCP575, “Casualty Insurance Policy Information Sheet”|
||Explanation of Form PDS-38B, "Nebraska Health Connection ID Document"|
||Nebraska Health Connection: Listing of Plans and Vendors|
||Explanation of Nebraska Medicaid Eligibility Documents|
||Instructions for Using the Nebraska Medicaid Eligibility System (NMES)|
||Explanation of Deleted Medicaid Claims Weekly Report (MCP564-D)|
||Explanation of Medicaid Claims in Process Over 30 Days Report (MCP564-S)|
||Nebraska Medicaid RN/LPN Fee Schedule|
Go to Rules and Regulations and Provider Bulletins for all Medicaid regulations, appendices and bulletins.
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