Nebraska Medicaid Program

Paper Claim Return Notice FAQ

Stated below are the top reasons why a paper claim is being returned and an explanation of what should be sent. Paper claims sent back to providers for correction will have a Return Notice attached, and the box(es) checked, indicating what's needed. Without the required information, claims cannot be entered into the Medicaid Management Information System (MMIS) for processing. Sample Return Notices are available below.

Missing/Invalid/Incomplete patient’s 11-digit Medicaid Identification Number

Nebraska Medicaid Requires the Patient's 11-digit Medicaid ID Number in order to adjudicate any claim.  When the Medicaid ID Number   is Invalid or Missing the claim must be returned.

CMS 1500 Billing Instruction: (See PDF471-000-62 page 3 in the 471 Appendix).

Field 1A. INSURED'S I.D. NUMBER: Enter the Medicaid client's complete eleven-digit identification number (Example: 123456789-01).

UB-04 Billing Instruction: (See PDF471-000-83 page 6 in the 471 Appendix).

Field 60. Insured’s Unique Identification Required

Enter the Medicaid client's complete eleven-digit identification number (example: 123456789-01).

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My claim was returned for missing/invalid dates of service.

Nebraska Medicaid requires the 8-digit numeric date of service for each procedure/service billed. When the information is missing or invalid the claim must be returned for correction.

CMS 1500 Billing Instruction: (See PDF471-000-62 page 5 in the 471 Appendix).

Field 24A. DATE(S) OF SERVICE: In the unshaded area, enter 8-digit numeric date of service rendered. Each procedure code/service         billed requires a date. Each service must be listed on a separate line. The "From" date of service must be completed. The "To" date of service may be left blank. If billing for CONSECUTIVE days at the same care level, claims must state the beginning (under “From”) and ending date (under “To”).

UB-04 Billing Instruction: (See PDF471-000-83 page 3 in the 471 Appendix).

Field 6. Statement Covers Period Required.

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My claim was returned because of a missing/invalid diagnosis code.

Nebraska Medicaid requires a valid Diagnosis for the services reported on the claim form.  Any claim with an invalid or missing Diagnosis Code must be returned for correction.  Nebraska Medicaid does not accept E-Codes.

CMS 1500 Billing Instruction: (See PDF471-000-62 page 4 in the 471 Appendix)

Field 21. DIAGNOSIS OR NATURE OF ILLNESS OF INJURY: The services reported on this claim form must be related to the diagnosis entered in this field. V codes are accepted when submitting for HEALTH CHECK services and certain family planning services. Enter the appropriate International Classification of Disease, 9th Edition, Clinical Modification (ICD-9-CM) diagnosis codes.    The COMPLETE diagnosis code is required. (A complete code may include the third, fourth, and fifth digits, as defined in ICD-9-CM.) Up to four diagnoses may be entered. If there is more than one diagnosis, list the primary diagnosis first.

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My claim was returned because of a missing/invalid place of service code.

Nebraska Medicaid requires the national two-digit place of service codes on all claims submitted on the CMS 1500 form.  Claims will be returned if no information is present in this field or the information submitted is invalid.

CMS Billing Instruction: (See PDF471-000-62 page 5 in the 471 Appendix)

Field 24B. PLACE OF SERVICE: In the unshaded area, enter the national two-digit place of service code that describes the location the service was rendered. National place of service codes are defined by the Centers for Medicare and Medicaid Services (CMS) and published on the CMS web site at http://www.cms.hhs.gov.

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My claim was returned because of missing/invalid days/units.

Nebraska Medicaid requires a valid day/unit value on each claim.  This value measures the specific time or quantity increments associated with the billed service charge.  If this field is blank or invalid the claim must be returned to be corrected.

CMS 1500 Billing Instruction: (See PDF471-000-62 page 6 in the 471 Appendix).

Field 24G. DAYS OR UNITS: Enter the number of times the service was provided on the date of service. If the procedure code description includes specific time or quantity increments, each increment should be billed as one unit of service.

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My claim was returned because of missing/invalid total charge/fee.

Nebraska Medicaid requires the total of all charges found in Field 24F.  If the total is incorrect or missing the claim must be returned for correction.

CMS Billing Instruction: (See PDF471-000-62 page 7 in the 471 Appendix).

Field 28. TOTAL CHARGE: Enter the total of all charges in Field 24F. If more than one claim form is used to bill for services provided, EACH claim form must be submitted with the line items totaled. DO NOT carry charge forward to another claim form.

UB-04 Billing Instruction: (See PDF471-000-83 page 5 in the 471 Appendix).

Field 47. Total Charges (by Revenue Code Category) Required.

Total charges must be greater than zero unless two or more operative procedures during a single session are billed. Only the first procedure requires a charge. Do not submit negative amounts.

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My claim was returned because of a missing/invalid  authorized signature and date.

Nebraska Medicaid requires a signature from an authorized representative.  A signature stamp, computer-generated or typewritten signature will also be accepted.  If no information is present in the signature field, the claim must be returned for correction.

CMS Billing Instruction: (See PDF471-000-62 page 8 in the 471 Appendix).

Field 31. SIGNATURE OF PHYSICIAN OR SUPPLIER: The provider or authorized representative must SIGN and DATE the claim form. A signature stamp, computer-generated or typewritten signature will be accepted. The signature date must be on or after the dates of service listed on the form.

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My claim was returned because of a missing/invalid Provider's 11-Digit Medicaid Provider Number.

Nebraska Medicaid requires the Providers11-Digit Nebraska Medicaid Billing Provider Number to process any claim submitted.   If the Provider Number listed is invalid or missing the claim must be returned for correction.

CMS Billing Instruction: (See PDF471-000-62 page 8 in the 471 Appendix).

Field 33b. OTHER ID#: Enter the eleven-digit Nebraska Medicaid provider number as assigned by Nebraska Medicaid (example: 123456789-12). All payments are made to the name and address listed on the Medicaid provider agreement for this provider number.

UB-04 Instruction: (See PDF471-000-83 page 6 in the 471 Appendix).

Field 57. Other Provider Identifier.

A unique identification number assigned to the provider by the health plan.

Enter the eleven-digit Nebraska Medicaid provider number as assigned by Nebraska Medicaid (example: 123456789-12). All payments are made to the name and address listed on the Medicaid provider agreement for this provider number.

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My claim was returned because of the missing/invalid patient's gender.

Claims submitted on the UB-04 claim form require the patient’s gender to be reported.  If the information provided is invalid or missing the claim must be returned for correction.

UB-04 Billing Instruction: (See PDF471-000-83 page 3 in the 471 Appendix).

Field 11. Patient Sex Required

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My claim was returned because of missing/invalid revenue code.

Claims submitted on the UB-04 require a valid revenue code in order to be processed.  Any claim containing and invalid or missing revenue code must be returned for correction.

UB-04 Billing Instruction: (See PDF471-000-83 page 5 in the 471 Appendix).

Field 42. Revenue Code Required.

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My claim was returned because of a missing/invalid patient’s birth date.

All claims submitted on the UB-04 require the patient’s date of birth in order for the claim to be processed.  Any claim with an invalid or missing date of birth must be returned for correction.

UB-04 Billing Instruction: (See PDF471-000-83 page 3 in the 471 Appendix).

Field 10. Patient Birth date Required.

The patient is the person that received services.

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My claim was return because of a missing/invalid type of bill.

All claims submitted on the UB-04 require the type of bill in order to be processed.  Any claim with an invalid or missing type of bill must be returned for correction.

UB-04 Billing Instruction: (See PDF471-000-83 page 3 in the 471 Appendix).

Field 4. Type of Bill Required.

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My claim was returned because of a missing/invalid procedure code.

Nebraska Medicaid requires a procedure code on all claims submitted on the CMS 1500 claim form and on Inpatient Claims when applicable.  Claims must be returned for correction if the procedure code submitted is invalid or missing.

CMS 1500 Billing Instruction:  (See PDF471-000-62 page 6 in the 471 Appendix).

Field 24D. PROCEDURES, SERVICES, OR SUPPLIES: In the unshaded area, enter the appropriate CPT or HCPCS Level II procedure code and, if required, procedure code modifier. Procedure codes used by Nebraska Medicaid are listed in the Nebraska Medicaid Practitioner Fee Schedule (see PDF471-000-518, PDF471-000-533, and PDF471-000-540). Up to four modifiers may be entered for each procedure code. When using miscellaneous and not otherwise classified (NOC) procedure codes, a complete description of the service is required in the shaded area between 24D through 24H or as an 8 1/2 x 11 attachment to the claim.

For physician administered drugs, other than vaccines, enter the National Drug Code (NDC) in the upper shaded area of lines using HCPCS or CPT codes for a drug (24D through 24H).

For all physician administered drugs for which the billed amount is $500 or more, submit a copy of the invoice. This pricing will be entered onto the provider charge screen and another invoice will not be needed until there is a price change.

UB-04 Billing Instruction: (See PDF471-000-83 page 5 in the 471 Appendix).

Field 44. HCPCS/Rates/HIPPS Rate Codes Situational.

Rates are required on inpatient claims for accommodation rooms and on outpatient claims for dialysis services.

HCPCS procedure codes are required on inpatient claims for “other therapeutic services” (revenue codes 940 and 949). HCPCS procedure codes are required on all outpatient claims except pharmacy, supplies and dialysis. Up to four procedure code modifiers may be entered for each procedure code.

HIPPS rate codes are not used.

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My claim was returned stating all applicable attachments must be stabled to each claim form.

When submitting paper claims you must include all appropriate attachments on each claim form.  We are unable to accept multiple claims with only one Explanation of Benefits attached.  You must staple a copy to each claim in order for the claim to be accepted.  In addition, each claim needs to be separately totaled.

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877-255-3092 (toll free) or 471-9128

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