Nebraska Medicaid Program

Electronic Data Interchange (EDI)

EDI Submission Requirements

Requirements for exchanging electronic data with Nebraska Medicaid are included in the following document:

EDI Submission Requirements	Version	Published
Nebraska Medicaid X12 Submission Requirements Manual File Transfer Protocol (FTP)	1.13	07/10/06

Companion Guides for Nebraska Medicaid requirements for ASC X12 health care transactions.

Companion Guides	Version	Published
837I Institutional Claims	1.03	12/28/07
837P Professional Claims	1.06	12/28/07
837D Dental Claims	1.04	09/20/07
835 Remittance Advice	1.01	07/23/07
270 Eligibility Inquiry-271 Eligibility Response	1.04	05/19/08
276 Claim Status Request-277 Claim Status Response	1.02	10/20/04
278 Health Care Services Review	1.03	07/06/04
820 Premium/Capitation Payment	1.01	10/28/03
834 Benefit Enrollment & Disenrollment	1.02	07/06/04

All forms available on this page are in PDF format and require the use of Adobe Acrobat Reader which can be downloaded for free from Adobe Acrobat Systems, Inc.