Ambulance Provider Handbook

Medicaid Related Assistance
Medicaid & Long-Term Care

What would you like to do?

What you need to know

​This handbook is your primary resource on the Nebraska Medicaid program, including program regulations and service coverage requirements, as well as limitations, forms, billing requirements, and payment information.

Please review this handbook before providing services and requesting payment from Nebraska Medicaid, and share the handbook 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 this service type: Medicaid Contacts

Chapter 1​​Administration
​Chapter 2​Provider Participation
​Chapter 3​Payment for Medical Services
​Chapter 4​Ambulance Services


Appendices (Forms, Reports and Instructions)
​471-000-49​Claims Submission Table
​471-000-50​Standard Electronic Transaction Instructions
471-000-53​Nebraska Medicaid Billing Instructions for Ambulance Services
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
​471-000-85​Explanation of Remittance Advice and Refund Requests Report
​471-000-87Example 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)
​471-000-127​Explanation of Deleted Medicaid Claims Weekly Report (MCP564-D)
​471-000-128​Explanation of Medicaid Claims in Process Over 30 Days Report (MCP564-S)