Hospice 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.


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 36: Hospice Services

Appendices (Forms, Reports and Instructions)
471-000-49 Claims Submission Table
471-000-50 Standard Electronic Transaction Instructions
​471-000-51​Form CMS-1450 (UB-92), “Health Insurance Claim Form" (formerly HCFA-1450)
471-000-70 Nebraska Medicaid Billing Instructions for Medicare Crossover Claims
​471-000-78​Nebraska Medicaid Form Locator Requirements for Form CMS-1450 (UB-92)
471-000-79 Form EA-160, "Record of​ Health Cost-Share of Cost-Medicaid Program," and Completion Instructions
​471-000-81​Nebraska Medicaid Billing Instructions for Hospice Services
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 Ref​und Procedures
471-000-100 Form MCP575, "Ca​sua​lty In​s​urance Policy Information Sheet"
471-000-123 Explanation of Ne​braska Medicaid Eligibility Documents
471-000-124 Instructions f​or Using the Nebraska Medicaid Eligibility System (NMES)
471-000-127 Explanation of Deleted Medicaid Claims Weekly Report (MCP564-D)
471-000-128 Explana​tion of ​Medicaid Claims in Process Over 30 Days Report (MCP564-S)

​Explanation of Deleted Medi​caid Claims and Medicaid Claims in Process Over 30 Days Report (MCP564-DS)​

​Provider Bulletins ​
Provider Bulletin 16-07
​Hospice Payment Methodology Changes
Provider Bulletin 17-02
​Hospice in Nursing Facility Medicaid Provider Agreement​
Provider Bulletin 19-15
​Hospice Service Intensity Add-on (SIA) payments for fee-for-service Medicaid​
​Provider Bulletin 20-04
​Home Health and Hospice Agency Medicare Enrollment Requirement​