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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.
Regulations
The following chapters under Regulation Title 417 Nebraska Medical Assistance Program Services can be found on the Secretary Of State's website:
- Chapter 1: Administration
- Chapter 2: Provider Participation
- Chapter 3: Payment for Medical Services
- Chapter 8: Hearing Aids
| Appendices (Forms, Reports and Instructions) |
| 471-000-3 | Form DM-5H, “Physician's Report on Hearing Loss," and Completion Instructions |
| 471-000-49 | Claims Submission Table |
| 471-000-50 | Standard Electronic Transaction Instructions |
| 471-000-56 | Billing Instructions for Hearing Aid Services |
| 471-000-58 | Example of Form CMS-1500, "Health Insurance Claim Form" (formerly HCFA-1500) |
| 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"
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| 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) |
| 471-000-205 | Form MC-9HA, “Prior Authorization Document for Hearing Aids," and Completion Instructions |