NEBRASKA MEDICAID PROGRAM

Nebraska Medicaid Program

Provider Information

Physician/Laboratory 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.

Regulations

Table of Contents

Chapter 1	Administration
Chapter 2	Provider Participation
Chapter 3	Payment for Medical Services
Chapter 18	Physicians' Services
Chapter 33	Health Checks and Treatment Services for Conditions Disclosed during Health Checks (EPSDT)

Appendices (Forms, Reports and Instructions)

471-000-2	Form DM-5, “Physician’s Confidential Report” and Completion Instructions
471-000-10	Instructions for Completing “Nebraska Medicaid Telehealth Patient Consent” Form
471-000-38	Form EPSDT-5, “Health Check Plan of Care”, and Completion Instructions
471-000-49	Claims Submission Table
471-000-50	Standard Electronic Transaction Instructions
471-000-58	Example of Form CMS-1500, “Health Insurance Claim Form” (formerly HCFA-1500)
471-000-62	Billing Instructions for Physician, Laboratory, and Ambulatory Surgical Center (ASC) Services
471-000-66	Example of Form HCFA-1539, “Medicare/Medicaid Certification and Transmittal”
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
471-000-87	Example of Form MC-2, “Electronic Attachment Control Number Form”
471-000-90	Form MC-19, “Medical Assistance Provider Agreement” and Completion Instructions
471-000-99	Medicaid Claim Adjustment and Refund Procedures
471-000-100	Form MCP575, “Casualty Insurance Policy Information Sheet”
471-000-109	Form MMS-100, “Serilization Consent Form”, and Completion Instructions
471-000-110	Form MMS-101, “Informed Consent for Hysterectomies”, and Completion Instructions
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)
471-000-518	Nebraska Medicaid Practitioner Fee Schedule for Physician Services
471-000-520	Nebraska Medicaid Practitioner Fee Schedule for Clinical Lab
471-000-533	Nebraska Medicaid Practitioner Fee Schedule for HEALTH CHECK Services
471-000-540	Nebraska Medicaid Practitioner Fee Schedule for Injectables

Provider Bulletins

Number	Subject	Date
12-47	2012/2013 Medicaid RSV Infection Prophylaxis Update	09/25/12
12-09	Initial ICD-10 Awareness	02/07/12
11-51	Medicaid Prior Authorization: Enzyme-Replacement Therapy (ERT) for Lysosomal Storage Disorders (Replaces Provider Bulletin 08-01)	09/20/11
11-50	Billing for Physician Administered Medications on the Same Date as an Office Visit	09/20/11
11-13	UPDATE Nebraska Medicaid Implementation of the National Correct Coding Initiative Edits	02/11/11
10-60	A. Coverage of Zyprexa Relprevv B. Revised Risperdal Consta Authorization Requirements C. End Prior Authorization of Certain Psychiatric Injectable Medications	12/15/10
10-54	Preferred Drug List	10/22/10
10-39	Nebraska Medicaid Implementation of the National Correct Coding Initiative Edits	09/20/10
10-26	Secure Residential Rehabilitation Services	07/01/10
10-22	July 1, 2010 Rate Increase	06/25/10
09-32	Seasonal Influenza Vaccine-2009/2010 Update	09/01/09
09-32	Seasonal Influenza Vaccine-2009/2010 Update	09/01/09
09-26	2009/2010 Medicaid RSV Infection Prophylaxis Update	08/20/09
09-16	Radiology Prior Authorization(s)	04/21/09
09-15	Physician Application of Fluoride Varnish	04/22/09
09-14	Coverage of Essure Sterilizations	06/26/09
09-04	Primary Care Case Management (PCCM) Referral/Authorization for Physician Services	02/25/09
09-02	Provider responsibility to screen employees and contractors for HHS-OIG exclusion status	02/04/09
08-39	Coverage of Tobacco Cessation Midrin Coverage	12/04/08
08-32	2008/2009 Medicaid RSV Infection Prophylaxis Update (Replaces Bulletin 07-26)	9/18/08
08-31	Influenza Vaccine - 2008/2009 Update (Replaces Bulletin 07-24)	09/18/08
08-24	Fee Schedule Update	06/26/08
08-13	1.) Elimination of Claims Attachment Requirements for Certain Codes. 2.) Change of Coding Requirements for IUD Billing.	05/12/08
08-12	DHHS Website Email Notification Feature, Online Provider Handbooks and Provider Bulletins, Electronic Claims, Funds Transfer and Other Options	05/12/08
08-08	Fee Schedule Rate Changes for Radiology Services	03/10/08
08-06	Tamper-Resistant Presciption Pads for the Nebraska Medicaid Pharmacy Program (Revised)	03/14/08
08-03	National Drug Code (NDC) Requirements for Physician Administered Medication	01/31/08
08-01	Medicaid Prior Authorization: Enzyme-Replacement Therapy (ERT) for Lysosomal Storage Disorder (Rescind effective 09/20/11)	01/14/08
07-26	2007/2008 Medicaid RSV Infection Prophlaxis Update (Rescind effective 09/17/08)	10/12/07
07-24	Influenza Vaccine - 2007/2008 Update (Rescind effective 09/18/08)	10/05/07
07-23	Peer Review Organization	10/09/07
07-20	Tamper-Resistant Prescription Pads for the Nebraska Medicaid (Rescind effective 03/14/08)	09/05/07
07-11	Growth Hormone Criteria	05/15/07
07-10	New Medicaid Claim Reports – New Process for Reporting Deleted Medicaid Claims	05/09/07
07-05	Medicaid Coverage for Human Papillomarvirus (HPV) Vaccine	03/08/07
07-04	Medicaid Reimbursement for End State Renal Disease (ESRD) Laboratory Tests	02/13/07
07-01	Correct Claim Submission for Frames and Lenses	01/03/07
06-15	Medicaid Coverage for Rotavirus Vaccine	06/19/06
06-03	Medicaid Coverage for Hepatitis A Vaccinne and Measles, Mumps, Rubella, and Varicella (MMRV) Vaccine	01/10/06
05-34	Polycarbonate Lenses	12/05/05
05-30	Medicaid Coverage of Meningococcal Conjugate Vaccine & Tetanus, Diphteria, Acellular Pertussis Vaccine	10/20/05
05-22	Billing Instructions Revision for Physicians with Pathology Speciality	08/15/05
05-15	Eyeglass Replacement, Eye Examination, Vision Condition Codes, and Lens Tints	07/11/05
05-11	Radiology Contrast Coding – Q Codes	05/31/05
04-21	Risperdal Consta	10/21/04
04-04	Medicaid Coverage of Xolair®	03/24/04
03-27	Clarification for the use of CPT Procedure Codes 92225 and 92226	11/03/03

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