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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 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) |
| 471-000-10 | Instructions for Completing “Nebraska Medicaid Telehealth Patient Consent" Form
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| 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"
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| 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) |