Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES
Chapter 16 - PHARMACY SERVICES
Section 471-16-016 - BILLING REQUIREMENTS

Universal Citation: 471 NE Admin Rules and Regs ch 16 ยง 016

Current through September 17, 2024

016.01 DRUG CLAIMS. Claims for pharmacy services must meet the requirements listed in the Nebraska Point of Purchase System user's manual. The same standards apply to non-Point of Purchase system claims.

016.02 MEDICAL SUPPLIES AND DURABLE MEDICAL EQUIPMENT CLAIMS. Providers must bill electronically using the standard Health Care Claim: Professional transaction or the Health Insurance Claim Form to submit claims for medical supplies and durable medical equipment unless otherwise stipulated.

016.03 ELECTRONIC MEDIA CLAIM REQUIREMENTS. While the Department utilizes the Nebraska Point of Purchase System, providers are responsible for any errors, omissions, or inappropriate billings submitted by themselves or on their behalf by billing agents. The submission of any electronic media claim for reimbursement by the provider or by an approved company or organization on behalf of an approved provider constitutes certification of:

(A) The services or items for which payment is claimed were provided in compliance with the provisions of Title VI of the Civil Rights Act of 1964 and section 504 of the Rehabilitation Act of 1973:

(B) The amounts claimed are in accordance with the Department's regulations, and no additional charge, other than Medicaid copayment, has been or will be claimed:

(C) Each service is documented and the documentation is open to audit by the Department or its agents: and

(D) The charge does not exceed the pharmacy's usual and customary charge to the general public.

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