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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 website:
- Chapter 1: Administration
- Chapter 2: Provider Participation
- Chapter 3: Payment for Medical Services
- Chapter 7: Durable Medical Equipment and Medical Supplies
- Chapter 8: Home Health Agencies
| Appendices (Forms, Reports and Instructions) |
| 471-000-10 | Instructions for Completing “Nebraska Medicaid Telehealth Patient Consent" Form |
| 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) |
| 471-000-57 | Billing Instructions for Home Health Agency 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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| 471-000-90 | 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) |
| 471-000-129 | Explanation of Deleted Medicaid Claims and Medicaid Claims In Process over 30 Days Report (MCP564-DS) |
| 471-000-206 | Form MS-77, "Request for Prior Authorization," and Completion Instructions
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| 471-000-207 | Instructions for Completing Form MS-78, "Augmentative Communication Device Selection Report" |
| 471-000-208 | Form MS-79, "Wheelchairs and Wheelchair Seating System Equipment Selection Report," and Completion Instructions |
| 471-000-209 | Form MS-80, "Air Fluidized and Low Air Loss Bed Certification of Medical Necessity," and Completion Instructions |