All Insurance Policy Changes (Page 781)

Continuing from page 780. Showing older policy changes tracked across all payers. Use the filters in the related-hubs section below to narrow by provider, state, or specialty.

Medium impact
Reminder of Valid Electronic Signature Criteria
Texas Medicaid·Identified Jun 20, 2026
TMHP has clarified acceptable electronic signature requirements for Texas Medicaid prior authorizations and required forms. Only software-generated electronic signatures with timestamps/logos and audit trails are acceptable - typed signatures, photocopies, and ink stamps are explicitly prohibited.
Medium impact
Newsletter Vol. 3, No. 39
New Jersey Medicaid·Effective Feb 1, 1900
This policy expands Medicaid and SSI eligibility for low birth weight infants in New Jersey, establishing presumptive disability determinations for newborns meeting specific weight criteria (≤1,200 grams or 1,200-1,500 grams with small-for-gestational-age status). Billing teams must ensure parents/guardians file SSI applications immediately at birth to enable retroactive Medicaid coverage; eligibility is retroactive to the filing date for up to 3 months prior, even if SSI payments are not yet approved.
High impact
Newsletter Vol. 3, No. 40
New Jersey Medicaid·Effective Aug 1, 2024
New Jersey Medicaid now requires that clinical laboratory tests be billed ONLY by the CLIA-certified laboratory that actually performed the test, not by the originating provider or reference laboratory that collected the specimen. Providers may still bill separately for venipuncture/specimen collection. Originating labs that refer tests to reference labs cannot bill for the lab services themselves.
Medium impact
Provider Engagement Meeting for Medicaid Payment Rates
Texas Medicaid·Effective Jul 15, 2026
HHSC will hold virtual provider engagement meetings on July 15, 2026, to collect comments on Medicaid payment rates for long-term services and supports programs. Providers can participate in three sessions covering different service categories and provide input on potential rate changes for Q1 of state fiscal year 2027.
Medium impact
Newsletter Vol. 3, No. 41
New Jersey Medicaid·Identified Jun 20, 2026
This is a revision to manufacturer labeler codes used for pharmaceutical and medical supply billing. The policy updates the list of approved manufacturer codes that must be used when submitting claims for drugs and medical devices.
Low impact
Newsletter Vol. 3, No. 42
New Jersey Medicaid·Identified Jun 20, 2026
New Jersey Medicaid is conducting a survey to identify nursing facility residents with mental illness/mental retardation whose care is reimbursed through private pay, insurance, or non-Medicaid sources. This appears to be a data collection initiative rather than a billing policy change.
Medium impact
Newsletter Vol. 3, No. 43
New Jersey Medicaid·Identified Jun 20, 2026
Failed to analyze policy change
Low impact
Newsletter Vol. 3, No. 44
New Jersey Medicaid·Identified Jun 20, 2026
This policy adds eight pharmaceutical manufacturers to the New Jersey Medicaid Drug Rebate program's Manufacturers Labeler Code List. The additions include OrthoBiotech Inc, Lange Medical Products Inc, Mas Laboratories Inc, Boehringer Mannheim Pharmaceutical Corporation, Elge Inc, Venture Pharmaceuticals Inc, Warrick Pharmaceuticals, and Cypress Pharmaceuticals Inc. Billing teams should note that Medicaid and PAAD Drug Rebate program coverage may vary based on manufacturer participation in these drug rebate programs.
Low impact
Newsletter Vol. 3, No. 45
New Jersey Medicaid·Effective Oct 1, 2024
The Hudson County Medicaid District Office is relocating to Summit Avenue in Jersey City, New Jersey, effective October 2024. Providers must update contact information and direct all inquiries to the new office address and phone number provided.
Medium impact
Newsletter Vol. 3, No. 46
New Jersey Medicaid·Identified Jun 20, 2026
New Jersey Medicaid clarifies that pharmacies must obtain proper prescriber authorization (written statement of 'Brand Necessary' or 'Medically Necessary') when dispensing brand drugs when approved generic drugs are unavailable due to market supply fluctuations. Payments for brand drugs dispensed without proper authorization will be subject to recapture during pharmacy audits.
Medium impact
Newsletter Vol. 3, No. 47
New Jersey Medicaid·Identified Jun 20, 2026
New Jersey Medicaid program is deleting specific pharmaceutical drugs from the Federal Medicaid Upper Limits (MAC) list effective June, July, and August. Affected drugs include Amiloride Hydrochloride, Butabarbital Sodium, Dexchlorpheniramine Maleate, Chloramphenicol, Potassium Chloride, Sulfacetamide Sodium, and Aspirin/Oxycodone combinations. Reimbursement will now be based on the lower of AWP minus applicable discounts plus dispensing fee or Usual and Customary Charge for all New Jersey Medicaid programs (Medicaid, PAAD, GAP, CFDP, GSHP, and ADDP).
High impact
Newsletter Vol. 3, No. 48
New Jersey Medicaid·Identified Jun 20, 2026
New Jersey hospitals not reimbursed under Medicaid DRG methodology must now bill therapeutic leave days as residential days using Accommodation Revenue Code. Hospitals can submit claims for entire stays or portions of stays that include therapeutic leave days without preparing separate discharge/readmission claim forms.
Low impact
Medicaid Alert - MA-1993-20
New Jersey Medicaid·Identified Jun 20, 2026
Medicaid has issued clarification on billing procedures for hearing aid batteries using HCPCS code Y4400. This policy provides updated guidance on proper documentation and billing requirements for this specific durable medical equipment item.
Medium impact
Medicaid Alert - MA-1993-21
New Jersey Medicaid·Identified Jun 20, 2026
This is a provider notice regarding Medicare/Medicaid crossover claims processing. The policy likely addresses billing procedures, coordination of benefits, or payment processes for patients who have both Medicare and Medicaid coverage.
Low impact
Newsletter Vol. 3, No. 49
New Jersey Medicaid·Identified Jun 20, 2026
New pharmaceutical manufacturers have been added to the PAAD (Pharmaceutical Assistance to the Aged and Disabled) program's approved labeler code list. This expands the list of drug manufacturers whose products are covered under New Jersey's prescription assistance program for elderly and disabled patients.
Medium impact
Newsletter Vol. 3, No. 50
New Jersey Medicaid·Identified Jun 20, 2026
This policy clarifies influenza immunization coverage and billing procedures for Medicaid recipients in long-term care settings. Key updates: (1) Physicians cannot bill for vaccine administration when facility staff administers it; (2) For dually eligible Medicare/Medicaid recipients, the Medicare intermediary must be billed for the influenza vaccine, not Medicaid.
Medium impact
Newsletter Vol. 3, No. 51
New Jersey Medicaid·Identified Jun 20, 2026
This policy updates the New Jersey Medicaid program's manufacturer labeler code list by adding 7 new pharmaceutical manufacturers and removing 5 existing ones from the reimbursable provider list. Billing teams must stop reimbursing the deleted manufacturers effective on their indicated dates and begin processing claims from the newly added manufacturers.
Medium impact
Newsletter Vol. 3, No. 52
New Jersey Medicaid·Identified Jun 20, 2026
New newsletter Vol. 3, No. 52 announces a Traumatic Brain Injury (TBI) Program. Without access to the full policy document, specific billing changes and requirements cannot be determined from the summary alone.
High impact
Newsletter Vol. 3, No. 54
New Jersey Medicaid·Effective Sep 1, 2024
New Jersey Medicaid is reinstating the requirement to use quadrant designation codes (UL, UR, LL, LR) when billing for specific dental procedures. Effective September 2024, all claims for the listed periodontal and oral surgery procedures must include the appropriate quadrant code in Field F (Tooth Code) on dental claim forms, or claims will be pended for duplicate editing.
Medium impact
Newsletter Vol. 3, No. 53
New Jersey Medicaid·Identified Jun 20, 2026
This policy updates the New Jersey Medicaid program's list of approved pharmaceutical manufacturers. Three manufacturers (Genetco Incorporated, Pennex Pharmaceuticals Incorporated, and Swiss American Products Incorporated) have been added and are now reimbursable. One manufacturer (Esquire Pharmaceuticals Incorporated) has been deleted and will no longer be reimbursed as of the effective date. Coverage may vary based on manufacturer participation in Drug Rebate programs.
Low impact
Newsletter Vol. 3, No. 55
New Jersey Medicaid·Identified Jun 20, 2026
This policy update adds new pharmaceutical manufacturers to the New Jersey PAAD (Pharmaceutical Assistance to the Aged and Disabled) program's approved labeler code list. The changes expand prescription drug coverage options for eligible New Jersey seniors and disabled patients.
Medium impact
Newsletter Vol. 3, No. 56
New Jersey Medicaid·Identified Jun 20, 2026
New Jersey Medicaid no longer requires prior authorization for electrolyte replacement supplements (Pedialyte, Ricelyte, and generically equivalent products), effective immediately. However, Garden State Health Plan and private HMO policies may still require prior authorization, so billing teams must verify requirements by individual plan.
Medium impact
Newsletter Vol. 3, No. 57
New Jersey Medicaid·Effective Dec 1, 1993
New Jersey Medicaid has updated the Maximum Allowable Cost (MAC) drug list with revised Federal Upper Limits of Payment for pharmaceutical services. Providers must replace the previous MAC drug list (Rev 11/93) with the new Rev 12/93 list and insert it as Appendix B in their pharmaceutical services manual.
Medium impact
Newsletter Vol. 3, No. 58
New Jersey Medicaid·Identified Jun 20, 2026
New Jersey Medicaid will no longer reimburse for single-antigen measles, mumps, or rubella vaccines when the combined MMR vaccine is medically appropriate. Providers must use the trivalent MMR vaccine (HCPCS code 90707) except in specific medical emergencies or when MMR is medically contraindicated and properly documented.
Medium impact
Newsletter Vol. 3, No. 59
New Jersey Medicaid·Identified Jun 20, 2026
This is a provider notice regarding Personal Care Assistant (PCA) Services from New Jersey Medicaid. Without access to the full policy content, the specific changes to PCA billing, coverage, or requirements cannot be determined from the summary information provided.

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Archive by year

2023 2024 2025 2026

Reminder of Valid Electronic Signature Criteria

Newsletter Vol. 3, No. 39

Newsletter Vol. 3, No. 40

Provider Engagement Meeting for Medicaid Payment Rates

Newsletter Vol. 3, No. 41

Newsletter Vol. 3, No. 42

Newsletter Vol. 3, No. 43

Newsletter Vol. 3, No. 44

Newsletter Vol. 3, No. 45

Newsletter Vol. 3, No. 46

Newsletter Vol. 3, No. 47

Newsletter Vol. 3, No. 48

Medicaid Alert - MA-1993-20

Medicaid Alert - MA-1993-21

Newsletter Vol. 3, No. 49

Newsletter Vol. 3, No. 50

Newsletter Vol. 3, No. 51

Newsletter Vol. 3, No. 52

Newsletter Vol. 3, No. 54

Newsletter Vol. 3, No. 53

Newsletter Vol. 3, No. 55

Newsletter Vol. 3, No. 56

Newsletter Vol. 3, No. 57

Newsletter Vol. 3, No. 58

Newsletter Vol. 3, No. 59