Mental Health and Substance Abuse 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

Table of Contents
Chapter 1 Administration
Chapter 2 Provider Participation
Chapter 3 Payment for Medical Services
​Chapter 20​Psychiatric Services for Individuals Age 21 and Older
​Chapter 32​Mental Health and Substance Abuse Treatment Services for Children and Adolescents
​Chapter 35​Rehabilitative Psychiatric Services


Appendices (Forms, Reports and Instructions)
471-000-10Instructions for Completing “Nebraska Medicaid Telehealth Patient Consent" Form
​471-000-40​Form FA-20, “Cost Report of Psychiatric and Chemical Dependency Facilities for Medicaid Reimbursement", and Completion 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)
​471-000-58​Example of Form CMS-1500, “Health Insurance Claim Form" (formerly HCFA-1500)
​471-000-64​Billing Instructions for Mental Health and Substance Abuse Services
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
471-000-85 Explanation of Remittance Advice and Refund Requests Report
471-000-87 Example of Form MC-2, "Electronic Attachment Control Number Form"
471-000-89​Form MC-14, “Confidential Report", and Completion Instructions
471-000-90 Form MC-19, "Medical Assistance Provider Agreement" and Completion Instructions
​471-000-91​Form MC-20, “Medicaid Hospital 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
471-000-127 Explanation of Deleted Medicaid Claims Weekly Report (MCP564-D)
471-000-128 Explanation of Medicaid Claims in Process Over 30 Days Report (MCP564-S)
471-000-129​Explanation of Deleted Medicaid Claims and Medicaid Claims In Process over 30 Days Report (MCP564-DS)


Provider Bulletins
​Provider Bulletin 13-66​Mental Health and Substance Use Copay Deductions
Provider Bulletin 13-38​Behavioral Health Evaluation & Management (E/M) Services in a Nursing Facility or PRTC
Provider Bulletin 13-06​Mental Health and Substance Use January 1, 2013 CPT Code Changes
Provider Bulletin 11-69​Medicaid Copayments for Mental Health and Substance Abuse Services
Provider Bulletin 11-61​Billing for Multiple Services on the Same Service Date
Provider Bulletin 07-29​Procedure Code Change for the Annual Assessment by Psychologists