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5010 Trading Partner Enrollment Forms
All trading partners will be required to enroll and pass the testing process prior to exchanging 5010 transactions.
New Trading Partners:
Complete and mail the original, signed copy of the trading partner agreement to:
Department of Health and Human Services
ATTN: Medicaid EDI Help Desk
P.O. Box 95026
Lincoln, NE 68509-5026
The trading partner profile and trading partner authorization forms can be emailed or faxed after completion. Fax: (402) 742-2353; Email:
DHHS.MedicaidEDI@nebraska.gov.
Current Trading Partners:
If you are an enrolled trading partner, but would like to add a new transaction, complete a new Nebraska Medicaid trading partner profile. Fax (402) 742-2353, Email or mail the completed form to the address listed above. Contact the EDI Help Desk to begin
EDI Testing.
To begin or discontinue submitting transactions for a provider, complete a Nebraska Medicaid trading partner authorization.