Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES
Chapter 3 - PAYMENT FOR MEDICAID SERVICES
Section 471-3-004 - BILLING REQUIREMENTS

Universal Citation: 471 NE Admin Rules and Regs ch 3 ยง 004

Current through September 17, 2024

004.01 CLAIMS SUBMISSION. Providers will submit claims for payment for medical services on the appropriate Medicaid billing forms as identified by the Department or the appropriate health care claim format for electronic transactions. Billing requirements for specified services are found in the applicable 471 NAC chapter.

004.02 CLAIM CERTIFICATION. The submission of the claim form by the provider, the provider's authorized representative, or the provider's billing agent on behalf of an approved provider certifies:

(A) The services were medically indicated and necessary to the health of the patient, and were personally rendered by the provider or under the provider's direction;

(B) The services 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;

(C) The amounts claimed are in compliance with the Department's policies, and no additional charge has been or will be made;

(D) The information on the claim is true, accurate, and complete;

(E) Each service is documented in the provider's files, and documentation is available to the Department, the United States Department of Health and Human Services, and state and federal fraud and abuse units; and

(F) The provider understands payment and resolution of this claim will be made from federal and state funds, and any false claims, statements, or documents, or concealment of a material fact may be prosecuted under applicable federal or state laws.

004.03 PAPER SUBMISSION. The provider, the provider's authorized representative, or the provider's billing agent on behalf of an approved provider must sign the paper Medicaid billing forms which contain signature fields. Computer generated signatures are accepted and must be the signature of the service rendering provider, not the clinic or corporation. When a computer-encoded document is used as the Medicaid billing mechanism, the Department may request the provider's source input document from the provider for input verification and signature requirements. The signature constitutes certification as required by this chapter.

004.04 ELECTRONIC SUBMISSION. The submission of any electronic claim by the provider, the provider's authorization representative, or the provider's billing agent on behalf of an approved provider constitutes certification as required by this chapter.

004.05 ELECTRONIC CLAIMS AND COMPUTER ENCODED CLAIM DOCUMENTATION. The provider will allow the authorized representatives of the United States Department of Health and Human Services, the Department, and state and federal fraud and abuse units to review and audit the provider's or the provider's billing agent's or clearinghouse's data processing procedures and supportive software documentation involved in the production of the computer-encoded claims or electronic claims submitted to the Department. The provider has agreed to allow the Department and its authorized representatives access to its records under the service provider agreement.

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