Nebraska Medicaid Program
Provider Information
Pharmacy 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:  Contact Medicaid.
Regulations
Appendices (Forms, Reports and Instructions)
| 471-000-49 |
Claims Submission Table |
| 471-000-50 |
Standard Electronic Transaction Instructions |
| 471-000-55 |
Billing Instructions for Durable Medical Equipment, Medical Supplies, Orthotics and Prosthetics |
| 471-000-58 |
Example of Form CMS-1500, “Health Insurance Claim Form” (formerly HCFA-1500) |
| 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 |
| 471-000-84 |
Form MC-6, “Physician’s Certification Form”, and Completion Instructions |
| 471-000-85 |
Explanation of Remittance Advice and Refund Requests Report |
| 471-000-86 |
Example of Form MC-38, “Notice of Lock-In Finding” |
| 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 |
| 471-000-93 |
Instructions for Completing Form MC-66, “Recipient Choice of Provider Agreement” |
| 471-000-99 |
Medicaid Claim Adjustment and Refund Procedures |
| 471-000-100 |
Form MCP575, “Casualty Insurance Policy Information Sheet” |
| 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) |
| 471-000-126 |
Procedure Codes Subject to Copayment Requirements |
| 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) |
| 471-000-206 |
Form MS-77, “Request for Prior Authorization,” and Completion Instructions |
| 471-000-207 |
Instructions for Completing Form MS-78, “Augmentative Communication Device Selection Report” |
| 471-000-208 |
Form MS-79, “Wheelchairs and Wheelchair Seating System Equipment Selection Report,” and Completion Instructions |
| 471-000-209 |
Form MS-80, “Air Fluidized and Low Air Loss Bed Certification of Medical Necessity,” and Completion Instructions |
| 471-000-507 |
Nebraska Medicaid Practitioner Fee Schedule for Durable Medical Equipment, Medical Supplies, Orthotics and Prosthetics |
Provider Bulletins
| Number |
Subject |
Date |
| 12-09 |
Initial ICD-10 Awareness |
02/07/12 |
| 11-13 |
UPDATE Nebraska Medicaid Implementation of the National Correct Coding Initiative Edits |
02/11/11 |
| 10-54 |
Preferred Drug List |
10/22/10 |
| 10-39 |
Nebraska Medicaid Implementation of the National Correct Coding Initiative Edits |
09/20/10 |
| 09-02 |
Provider responsibility to screen employees and contractors for HHS-OIG exclusion status |
02/04/09 |
| 08-40 |
Medicaid Coverage of Tobacco Cessation, Omeprazole & Midrin |
12/08/08 |
| 08-33 |
Tamper-Resistant Prescription Pads for the Nebraska Medicaid Pharmacy Program Update (Replaces Bulletin 08-06 Issued 03/14/08 |
09/17/08 |
| 08-23 |
Durable Medical Equipment (DME) Fee Schedule Rate Changes |
07/01/08 |
| 08-14 |
Reimbursement for Wheelchairs Provided to Clients Residing in Nursing Facilities (Bulletin to DME Suppliers) |
05/01/08 |
| 08-12 |
DHHS Website Email Notification Feature, Online Provider Handbooks and Provider Bulletins, Electronic Claims, Funds Transfer and Other Options |
05/12/08 |
| 08-07 |
Fee Schedule Rate Changes for Oxygen Services |
03/10/08 |
| 08-06 |
Tamper-Resistant Presciption Pads for the Nebraska Medicaid Pharmacy Program (Rescind effective 09/17/08) |
03/14/08 |
| 07-27 |
Cough and Cold Covered Products |
10/25/07 |
| 07-20 |
Tamper-Resistant Prescription Pads for the Nebraska Medicaid (Rescind effective 03/14/08) |
09/05/07 |
| 07-12 |
Hepatitis C PA Criteria, Byetta PA Form, Cox II Criteria |
5/15/07 |
| 07-11 |
Growth Hormone Criteria |
05/15/07 |
| 07-10 |
New Medicaid Claim Reports – New Process for Reporting Deleted Medicaid Claims |
05/09/07 |
| 07-06 |
NPI, Prior Authorization, TPL, Byetta PA Form, New Drug PA Form |
04/05/07 |
| 06-29 |
Quantity or High Dose Overrides |
12/29/06 |
| 06-25 |
Change to Early Refill on Controlled Substances |
09/28/06 |
| 06-24 |
Nutritional Supplementation |
09/15/06 |
| 06-06 |
Eliminating Medicaid Coverage of Drugs for Sexual or Erectile Dysfunction; Medicare Part D |
02/02/06 |
| 05-35 |
Implementation of Medicare Part D |
12/14/05 |
| 05-24 |
Nutritional Supplement Claim Submission and Reimbursement |
09/14/05 |
| 05-07 |
Reimbursement for Wheelchairs Provided to Clients Residing in Nursing Facilities (Bulletin to DME Suppliers) (Rescind effective 05/01/08) |
05/22/05 |
| 04-21 |
Risperdal Consta |
10/21/04 |
| 04-04 |
Medicaid Coverage of Xolair® |
03/24/04 |
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. |