Medicaid Member Reimbursement

 
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Medicaid Related Assistance
Medicaid & Long-Term Care
 
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What you need to know

​​​​​​​Restoring Benefits​​​

Nebraska Medicaid is fully restoring the benefits of any member who experienced a reduction in benefits during the COVID-19 pandemic as a result of federal regulation. 

What does this mean?​​

Any Nebraska Medicaid member whose benefits were reduced during the COVID-19 pandemic, is having their benefits fully restored. This means they will be repaid for any service Medicaid would have covered during this time. Affected members are receiving a notice in the mail. 

If a member paid a medical bill (such as a copay at their doctor's office), the member can contact their medical provider to be repaid. The provider has six months from the date listed on the member's notice to submit a reimbursement request to Nebraska Medicaid.​

If a member paid a copay for a prescription drug to their pharmacy, the member can request their prescription history from their pharmacy​ to include in their repayment request. The member has six months from the date listed on their notice to submit a reimbursement request to Nebraska Medicaid.​

I'm a member. How do I make sure I am repaid?

​If you received a letter from Nebraska Medicaid, you can be repaid for any co-pays or other bills that Medicaid should have covered. 

  • Contact your doctor. Your doctor should submit bills for services you paid for out of pocket to Nebraska Medicaid.
    • To help your doctor know you are eligible for repayment, show them the notice you received from Nebraska Medicaid.
    • After the reimbursement request is reviewed, your doctor will be repaid by Nebraska Medicaid. After your doctor is repaid,​​ they will then repay you for your out-of-pocket costs.
  • If you paid bills to the pharmacy throughout this time, you will need to submit your repayment request to Nebraska Medicaid within six months from the date listed on your notice. 
    • To do this you will need to submit a Member Reimbursemen​t Form​, State of Neb​raska ACH W-9 Enrollment Form, and attach a copy of your prescription history.
    • It may take up to 90 days for Nebraska Medicaid to process your payment request. This process may take longer if your request is missing information needed to determine if your claims are eligible for repayment.
    • You will be directly repaid for your out-of-pocket pharmacy expenses.

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