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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 18: Physicians' Services
- Chapter 33: Health Checks and Treatment Services for Conditions Disclosed During Health Checks (EPSDT)
| Appendices (Forms, Reports and Instructions) |
| 471-000-2 | Form DM-5, “Physician's Confidential Report," and Completion 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 |
| 471-000-58 | Example of Form CMS-1500, “Health Insurance Claim Form" (formerly HCFA-1500) |
| 471-000-62 | Billing Instructions for Physician, Laboratory, and Ambulatory Surgical Center (ASC) Services |
| 471-000-70 | Nebraska Medicaid Billing Instructions for Medicare Crossover Claims |
| 471-000-79 | Form EA-160, "Record of Health Cost-Share of Cost-Medicaid Program," and Completion Instructions |
| 471-000-84 | Form MC-6, “Physician's Certification Form," 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" |
| 471-000-109 | Form MMS-100, “Sterilization Consent Form," and Completion Instructions |
| 471-000-110 | Form MMS-101, “Informed Consent for Hysterectomies," and Completion Instructions |
| 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) |
| 471-000-126 | Procedure Codes Subject to Copayment Requirements |
| 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) |
| Provider Bulletins |
| Provider Bulletin 10-60 | A. Coverage of Zyprexa Relprevv
B. Revised Risperdal Consta Authorization Requirements
C. End Prior Authorization of Certain Psychiatric Injectable Medications |