Nebraska
Medicaid Program
Provider Information
Home Health 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)
| 471-000-10 |
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" |
| 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" |
| 471-000-121 |
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) |
| 471-000-129 |
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 |
| 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 |
| 471-000-507 |
Nebraska Medicaid Practitioner Fee Schedule for Durable Medical Equipment,
Medical Supplies, Orthotics and Prosthetics |
| 471-000-509 |
Nebraska Medicaid Home Health Agency Fee Schedule |
Provider Bulletins
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. |
