Please follow the Enrollment Instructions below to become an electronic submitter for Nebraska Medicaid.

Required Documents for those applying for new Submitter IDs

The following documents are required enrollment documents that must be completed, signed, and returned the NE Medicaid office prior to initiation of electronic claims submission or inquiry.

1. Nebraska Medicaid Trading Partner Profile

2. Nebraska Medicaid Trading Partner Authorization

3. Nebraska Medicaid Trading Partner Agreement

If the links listed above do not work properly, please download the forms from here:

http://dhhs.ne.gov/medicaid/Pages/med_edienroll-5010.aspx

If you have any questions regarding any of the documents in this package, please call the NE Medicaid EDI Technology Support Center at 1-866-498-4357, Option 1.

We can now process 276/277 requests (claim status). If this is a transaction you would like to utilize please make sure to enroll with the payer.

Nebraska Medicaid Trading Partner Profile

Section 1: Trading Partner Company Information

• Enter your Business/Practice or Provider Name

• Enter your Address

• For EIN/FTIN enter your Tax ID #

• For Trading Partner Type, please choose the appropriate type for your business

• Please enter your Operating System [i.e. Windows XP, Windows 2000, Windows 98 etc]

• For Software Vendor please enter the information for the software or vendor that creates your 837 files you need ClaimShuttle to transfer for you. If you have paid for our billing software please call our support line for our software information.

Section 2: Trading Partner Technical Contact Information- Testing

• Please enter the information for the main contact person for your office (usually the Billing Clerk)

Section 3: Trading Partner Technical Contact Information- Production

• Please enter the information from Section 2

Section 4 & 5: Trading Partner Contacts

• You may either skip these sections, or enter the same information from Section 2

Section 6:

• For EDI Qualifier please enter: ZZ

• For EDI ID, please select an ID you would like to use

  • Please Note: The ID must be less than 15 characters and all letters must be in CAPS

• For the Group ID, please enter the same ID you chose for your EDI ID

  • Please Note: The ID must be less than 15 characters and all letters must be in CAPS

Section 7: Transaction Sets
Please select the following:

• 837P- For Professional Claims (CMS 1500)

• 837I- For Institutional Claims (UB04)

• 835- Select this if you would like to receive your EOB's electronically in ClaimShuttle

• Select 277CA for Claims Acknowledgment

• Please leave the entire last page blank

Nebraska Medicaid Trading Partner Authorization

• Please complete the information with your (submitter) information and the provider's information for which you will be submitting

• For Transaction types please choose the following with today's date as the start date:

  • 837 Professional

  • 837 Institutional

  • 835 Remittance Advice

• Please complete the Signature Section on page 2

Nebraska Medicaid Trading Partner Agreement

• Please enter your Business/Practice or Provider name in the first paragraph

• Please complete the signature section for the "Trading Partner" on page 4

Submitting your Forms

It is recommended that you keep a copy of all the forms you will be submitting for your records: Mail 2 sets of Original enrollment forms reflecting original signatures to:

Department of Health and Human Services
Attn: Medicaid EDI Help Desk
P.O. Box 95026
Lincoln, NE 68509-5026

Mail or Fax (402-742-2353) the Trading Partner Profile and Trading Partner Authorization forms after completion.

It is very important that you complete and return the entire enrollment packet as described above. Incomplete packets will not be processed and will be returned to the submitter.

Waiting for a Response

Once the complete provider enrollment packet has been received, the documents will be processed. Processing will take approximately two weeks from the date of receipt. (Remember that mailing time can take as much as five days.)

After processing, a confirmation will be sent to you as notification to begin filing claims electronically. If neither confirmation nor a returned packet is received after two weeks, please contact the NE Medicaid EDI Technology Support Center at 1-866-498-4357, Option 1.

Testing

Once you have received your Submitter ID and Password from NE Medicaid, please call the ClaimShuttle Support Team and set an appointment for a Mailbox setup and Test Transmission to NE Medicaid.

Please have 25 test claims ready for testing. Test files should consist of a variety of claims that represent the type of claims you will be submitting once production status is achieved. Test claims will not be processed for payment but will be validated against production files; therefore, they must contain valid patient procedure, diagnosis, and provider information.