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.
If you have questions or comments about this information, contact the Medicaid program specialist for this service type: Medicaid Contacts
This handbook will be updated as regulations are updated.
| Appendices (Forms, Reports and Instructions) |
| 471-000-60 | Instructions for Completion of Form HHS-5N, “N-FOCUS Health and Human Services Billing Document" |
| 471-000-74 | Appendix 471-000-74 Instructions for Completing Form MC-39 |
| 471-000-94 | Instructions for Completing Form MC-84, “Personal Assistance Provider Check List" |
| 471-000-95 | “Service Needs Assessment/Plan" |
| 471-000-106 | “Provider Authorization" |
| 471-000-107 | Instructions for Completing Form MILTC-4D. "Physician/RN Statement for Health Maintenance Activities" |
| 471-000-108 | “Provider Authorization Update" |
| 471-000-112 | Instructions for Completing Form IRS-2678, "Employer Appointment of Agent" |
| 471-000-123 | Explanation of Nebraska Medicaid Eligibility Documents |
Additional Information
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Electronic Visit Verification
| The Federal 21st Century Cures Act (2016) required Nebraska to implement a new electronic visit verification (EVV) system for Personal Assistance Services providers. This system launched on January 3, 2021. EVV electronically captures and verifies provider visit information. |