471 Neb. Admin. Code, ch. 34, § 009
All RHCs must bill for Rural Health Services as defined in 471 NAC 34-003 on Form CMS-1450 or the standard electronic Health Care Claim: Institutional transaction (ASC X12N 837). RHCs will use the appropriate HCPCS/CPT procedure codes and revenue codes when billing for all services.
IRHCs must use Form CMS-1500 (see 471-000-58) or the standard electronic Health Care Claim: Professional transaction (ASC X12N 837) to bill NMAP for clinical radiology/laboratory services using the non-Rural Health Clinic provider number.
All Provider-Based RHCs must use Form CMS-1450 or the standard electronic Health Care Claim: Institutional transaction (ASC X12N 837) to bill NMAP for clinical laboratory services and radiology services using the hospital provider number.
471 Neb. Admin. Code, ch. 34, § 009