Nebraska Medicaid Program

Provider Information

Visual Care 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 24 Visual Care Services

PDF Appendices (Forms, Reports and 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)
471-000-65 Billing Instructions for Visual Care Services
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
471-000-85 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”
471-000-122 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)
471-000-524 Nebraska Medicaid Practitioner Fee Schedule for Visual Care Services

PDF Provider Bulletins

Number Subject Date
​14-12 Billing Instructions Updated – CMS 1500 and CMS 1450 (UB04) ​03/05/14
​13-82 Medicaid ICD-10 Implementation Project December 2013 Update ​12/20/13
​13-75 ​​Implementation of Revised CMS 1500 Claim Form / Version 02/12 ​11/14/13
​13-51 Affordable Care Act Administrative Simplification (AS) Requirements for HIPAA Electronic Transactions: Eligibility for a Health Plan (270/271) and Health Care Claim Status (276/277) ​07/19/13
​13-50 ​Timely Filing Requirement for all Medicaid Claims ​07/15/13
​12-52 Provider Screening and Enrollment ​10/12/12
​08-19 Benefit Limit for Frames and Lenses for Adults ​06/26/08

Correct Claim Submission for Frames and Lenses


Polycarbonate Lenses


Eyeglass Replacement, Eye Examination, Vision Condition Codes, and Lens Tints


Clarification for the Use of CPT Procedure Codes 92225 and 92226


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

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