Nebraska Medicaid Program

Provider Information

Mental Health & Substance Abuse Provider Enrollment

The following bulletins outline supplemental information that must be submitted with your provider agreement form:

• CP5 form -  Instructions for enrollment of traditional outpatient therapy services.

• CP6 form - Instructions for enrollment of acute inpatient, subacute, day treatment, and intensive outpatient services.

• Supervising Practitioner Statement

• Group Therapy Overview

• Integrated Practice Agreement - for Advanced Practice Registered Nurse (APRN) and agreement for Physican Assistant (PA).

• Community Treatment Aide I and II form - for Community Treatment Aide.

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