471 NAC 6-003. PROVIDER REQUIREMENTS

003. PROVIDER REQUIREMENTS. 003.01 GENERAL PROVIDER REQUIREMENTS. Providers of dental services must comply with all applicable provider participation requirements codified in 471 Nebraska Administrative Code (NAC) 2 and 3. In the event that provider participation requirements in 471 NAC 2 or 3 conflict with requirements outlined in this chapter, the individual provider participation requirements in this chapter will govern. 003.02 PROVIDER SPECIFIC REQUIREMENTS. If services are provided in another state, the dentist or dental hygienist must be licensed in that state, must practice within his or her scope of practice as defined by the licensing laws for that state, and must be enrolled in Medicaid by complying with the provider agreement requirements included in this chapter. 003.02(A) PROVIDER AGREEMENT. Providers of dental services must complete and sign Form MC-19, Service Provider Agreement, and submit the completed form to the Department for approval to participate in Medicaid.