Nebraska
Medicaid Program
Provider Information
Physician/Laboratory Provider Handbook
The links below comprise your Nebraska Medicaid Provider Handbook. This
handbook is your primary resource for information about the Nebraska Medicaid Program,
including program regulations, service coverage requirements and limitations, forms,
billing requirements, and payment information.
Please review this handbook prior to providing services and requesting payment from
Nebraska Medicaid and share it with personnel who perform referrals, authorization, coding
and claims submission for your office.
If you have questions or comments about this information, contact the Medicaid Program
Specialist for the type of service:  Contacts Medicaid.
Regulations
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 |
| 471-000-38 |
Form EPSDT-5, “Health Check Plan of Care”, and Completion
Instructions |
| 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 |
| 471-000-66 |
Example of Form HCFA-1539, “Medicare/Medicaid Certification and
Transmittal” |
| 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” |
| 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, “Serilization Consent Form”, and Completion
Instructions |
| 471-000-110 |
Form MMS-101, “Informed Consent for Hysterectomies”, and
Completion Instructions |
| 471-000-121 |
Explanation of Form PDS-38B, "Nebraska Health Connection ID
Document" |
| 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) |
| 471-000-518 |
Nebraska Medicaid Practitioner Fee Schedule for Physician Services |
| 471-000-533 |
Nebraska Medicaid Practitioner Fee Schedule for HEALTH CHECK Services |
| 471-000-540 |
Nebraska Medicaid Practitioner Fee Schedule for Injectables |
Provider Bulletins
| Number |
Subject |
Date |
| 08-24 |
Fee Schedule
Update |
06/26/08 |
| 08-13 |
1.)
Elimination of Claims Attachment Requirements for Certain Codes.
2.) Change of Coding Requirements for IUD Billing. |
05/12/08 |
| 08-12 |
DHHS Website
Email Notification Feature, Online Provider Handbooks and Provider Bulletins, Electronic
Claims, Funds Transfer and Other Options |
05/12/08 |
| 08-08 |
Fee Schedule
Rate Changes for Radiology Services |
03/10/08 |
| 08-06 |
Tamper-Resistant
Presciption Pads for the Nebraska Medicaid Pharmacy Program (Revised) |
03/14/08 |
| 08-04 |
Pregnancy -
Related Services for the Ineligible Mother of an Eligible Unborn Child |
02/11/08 |
| 08-03 |
National Drug
Code (NDC) Requirements for Physician Administered Medication |
01/31/08 |
| 08-01 |
Medicaid Prior
Authorization: Enzyme-Replacement Therapy (ERT) for Lysosomal Storage Disorder |
01/14/08 |
| 07-26 |
2007/2008
Medicaid RSV Infection Prophlaxis Update |
10/12/07 |
| 07-24 |
Influenza
Vaccine - 2007/2008 Update |
10/05/07 |
| 07-23 |
Peer Review
Organization |
10/09/07 |
| 07-20 |
Tamper-Resistant Prescription Pads for the
Nebraska Medicaid (Rescind effective 03/14/08) |
09/05/07 |
| 07-11 |
Growth Hormone
Criteria |
05/15/07 |
| 07-10 |
New Medicaid Claim Reports – New
Process for Reporting Deleted Medicaid Claims |
05/09/07 |
| 07-05 |
Medicaid
Coverage for Human Papillomarvirus (HPV) Vaccine |
03/08/07 |
| 07-04 |
Medicaid
Reimbursement for End State Renal Disease (ESRD) Laboratory Tests |
02/13/07 |
| 07-01 |
Correct Claim
Submission for Frames and Lenses |
01/03/07 |
| 06-15 |
Medicaid
Coverage for Rotavirus Vaccine |
06/19/06 |
| 06-03 |
Medicaid
Coverage for Hepatitis A Vaccinne and Measles, Mumps, Rubella, and Varicella (MMRV)
Vaccine |
01/10/06 |
| 05-34 |
Polycarbonate
Lenses |
12/05/05 |
| 05-30 |
Medicaid
Coverage of Meningococcal Conjugate Vaccine & Tetanus, Diphteria, Acellular Pertussis
Vaccine |
10/20/05 |
| 05-22 |
Billing
Instructions Revision for Physicians with Pathology Speciality |
08/15/05 |
| 05-15 |
Eyeglass
Replacement, Eye Examination, Vision Condition Codes, and Lens Tints |
07/11/05 |
| 05-11 |
Radiology
Contrast Coding – Q Codes |
05/31/05 |
| 04-21 |
Risperdal
Consta |
10/21/04 |
| 04-04 |
Medicaid
Coverage of Xolair® |
03/24/04 |
| 03-27 |
Clarification
for the use of CPT Procedure Codes 92225 and 92226 |
11/03/03 |
Go to Rules
and Regulations and Provider Bulletins
for all Medicaid regulations, appendices and bulletins.
Documents in PDF format require the use of Adobe Acrobat Reader which
can be dowloaded for free from Adobe Systems,
Inc. |
