All Insurance Policy Changes (Page 802)

Continuing from page 801. 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
Newsletter Vol. 8, No. 58
New Jersey Medicaid·Effective Sep 1, 1998
New Jersey Medicaid will begin recovering overpayments from Federally Qualified Health Centers (FQHCs) resulting from cost report settlements 30 days after providers receive their Notification of Final Settlement. FQHCs can appeal overpayment determinations within 30 days to delay collection, but must file formal appeals within 180 days.
Medium impact
Newsletter Vol. 8, No. 59
New Jersey Medicaid·Effective Sep 1, 1998
New Jersey Medicaid corrected the maximum fee allowances for HCPCS codes L8000 (breast prosthesis, mastectomy bra) and L8030 (breast prosthesis, silicone or equal) from fixed amounts ($16.00 and $125.00) to "By Report" pricing. Providers must now submit Adjustment Claim Forms (FD-999s) with approved pricing documentation to request payment adjustments for previously denied or underpaid claims.
Medium impact
Newsletter Vol. 8, No. 61
New Jersey Medicaid·Identified Jun 20, 2026
New Jersey Medicaid has updated Federal Upper Limits (FUL) for prescription drug reimbursement rates. This affects how much Medicaid will reimburse for covered prescription medications dispensed to Medicaid beneficiaries.
High impact
Newsletter Vol. 8, No. 62
New Jersey Medicaid·Effective Sep 1, 1998
New Jersey Medicaid and NJ KidCare-Plan A now require expanded concurrent review and assessment for Personal Care Assistant (PCA) services in six counties (Bergen, Essex, Hudson, Middlesex, Passaic, Union). Effective immediately, providers must submit FD-365 forms with PCA Socio-Medical Evaluation scales to the Medicaid District Office regardless of service hours (1-40 hours per week), with reassessments due within five working days and MDO review completed within 15 working days. Services may continue during review unless formal prior authorization for over 25 hours is required.
High impact
Newsletter Vol. 8, No. 63
New Jersey Medicaid·Identified Jun 20, 2026
New Jersey clarifies that partial care service billing must strictly exclude meal time, transport time, and non-active treatment time when determining full-day (5+ hours) or half-day (3-5 hours) eligibility. Providers submitting claims that don't meet these time requirements face administrative penalties, overpayment recovery, and potential program disqualification or criminal prosecution.
Medium impact
Newsletter Vol. 8, No. 64
New Jersey Medicaid·Effective Nov 1, 1998
New Jersey established the Medical Emergency Payment Program for Aliens, limiting coverage for ineligible aliens, undocumented aliens, and non-immigrants to emergency medical services only (acute hospital care and labor/delivery). Hospitals must verify eligibility through REVS/MEVS, attach physician certification (Form FD-80) for non-emergency diagnoses, and refer applicants to county social services within 3 months of service.
Medium impact
Newsletter Vol. 8, No. 65
New Jersey Medicaid·Identified Jun 20, 2026
Failed to analyze policy change
Low impact
Newsletter Vol. 8, No. 66
New Jersey Medicaid·Effective Nov 1, 1998
New Jersey Department of Human Services is adding two HCPCS procedure codes for psychiatric services (individual psychotherapy with medical evaluation and management) effective November 1, 1998, with established maximum fee allowances for physicians and non-physician practitioners.
Medium impact
Newsletter Vol. 8, No. 67
New Jersey Medicaid·Effective Nov 1, 1998
New Jersey DMAHS is adding two HCPCS procedure codes (90805 and 90807) for individual psychotherapy services with medical evaluation and management, effective for claims with service dates on or after November 1, 1998. Mental Health Clinics and Federally Qualified Health Centers must update their procedure code files and billing systems with the specified maximum fee allowances ($13.00 for 90805 and $26.00 for 90807).
Medium impact
Newsletter Vol. 8, No. 68
New Jersey Medicaid·Effective Nov 1, 1998
New Jersey Division of Medical Assistance and Health Services is adding two HCPCS procedure codes for psychiatric services provided by Certified Nurse Practitioners and Clinical Nurse Specialists, effective for claims with service dates on or after November 1, 1998. These codes (90805 and 90807) establish maximum fee allowances for individual psychotherapy with medical evaluation and management services at different time intervals.
Medium impact
Newsletter Vol. 8, No. 69
New Jersey Medicaid·Effective Dec 15, 1998
New Jersey Medicaid, NJ KidCare, and PAAD pharmacy providers must annually submit Form FD-70 (Pharmacy Provider Certification Statement) with a copy of their valid pharmacy permit to qualify for optional dispensing fee increments. Failure to submit by the deadline or incomplete submissions will result in providers being placed in the basic dispensing fee category without access to fee enhancements.
Medium impact
Newsletter Vol. 8, No. 70
New Jersey Medicaid·Effective Oct 1, 1998
New Jersey Medicaid and NJ KidCare programs are adding four pharmaceutical manufacturers to their drug rebate program (effective 10/01/98) and removing four manufacturers whose drugs will no longer be reimbursed. Billing teams must update their systems to recognize these manufacturer labeler code changes to ensure proper claim processing and avoid denials for non-covered manufacturers.
Medium impact
Newsletter Vol. 8, No. 71
New Jersey Medicaid·Effective Oct 1, 1998
New Jersey Medicaid and related programs (GA, ADDP, CF, PAAD) are updating the Maximum Allowable Cost (MAC) drug list effective October 1, 1998. Pharmacy providers and HMOs must replace the previous MAC drug list (Rev. 10/97) with the new revised list (Rev. 10/98) in their manuals. Changes to MAC limitations are highlighted in the attachment, and some MAC changes may have different effective dates than October 1, 1998.
Medium impact
Newsletter Vol. 8, No. 72
New Jersey Medicaid·Effective Jan 1, 1999
New Jersey is changing prior authorization procedures for mental health services effective January 1, 1999. PA requests must now be submitted to designated Medicaid District Offices based on provider county location instead of the OHSA office, and a new system edit will monitor the $6,000 PA threshold requirement.
Medium impact
Newsletter Vol. 9, No. 01
New Jersey Medicaid·Identified Jun 20, 2026
New monitoring system implemented for therapeutic duplication (PDUR) to identify when patients receive multiple similar medications that could cause harmful interactions or redundant therapy. This affects prescription-related billing and may impact prior authorization requirements for duplicate therapeutic classes.
High impact
Newsletter Vol. 9, No. 02
New Jersey Medicaid·Effective Jan 1, 1999
New Jersey's Newark and East Orange General Assistance programs are expanding prior authorization (PA) requirements to additional pharmaceutical drugs and entire therapeutic drug classes, effective January 1, 1999. Pharmacies must obtain PA from the DFD PA Unit (1-800-609-0106) for these newly covered drugs during business hours 8:30 A.M. to 4:30 P.M., Monday through Friday. A revised complete list of drugs requiring PA is attached to this newsletter.
Medium impact
Newsletter Vol. 9, No. 04
New Jersey Medicaid·Identified Jun 20, 2026
Failed to analyze policy change
Low impact
Newsletter Vol. 9, No. 05
New Jersey Medicaid·Identified Jun 20, 2026
Three new pharmaceutical manufacturers (HealthPoint Ltd/DPT Laboratories, Camall Co., and Centocor Inc.) have been added to the New Jersey PAAD (Pharmaceutical Assistance to the Aged and Disabled) Drug Rebate Program. Billing teams must recognize these manufacturers' labeler codes for proper claim processing, as PAAD coverage may differ from Medicaid based on manufacturer participation in their respective rebate programs.
High impact
Newsletter Vol. 9, No. 06
New Jersey Medicaid·Effective Nov 15, 1998
New Jersey Medicaid/PAAD implemented Prospective Drug Utilization Review (PDUR) duration standards effective November 15, 1998, to monitor prescription drug use for certain medications at approved daily dosage levels for acute medical conditions. Claims exceeding established duration limits will initially receive warning messages (Error Codes 403 and 404), with denials to follow once a Medical Exception Process is established. Pharmacists must contact the MEP contractor to obtain physician justification for prescriptions exceeding PDUR standards.
Medium impact
Newsletter Vol. 9, No. 11
New Jersey Medicaid·Effective Nov 15, 1998
New Jersey has activated PDUR monitoring Edit 536 for orally and nasally-administered inhalant solutions to track patient utilization and prevent overuse. Starting November 15, 1998, claims exceeding maximum days supply standards will generate a soft edit notification on the Point-of-Sale system, initially resulting in payment with an Explanation of Benefits message, but future policy changes may result in claim denials.
Medium impact
Newsletter Vol. 9, No. 3
New Jersey Medicaid·Identified Jun 20, 2026
New Jersey Medicaid/NJ KidCare has updated their eligibility identification cards. Healthcare providers need to be aware of the new card format and update their processes for verifying patient eligibility and benefits.
Low impact
Newsletter Vol. 9, No. 09
New Jersey Medicaid·Effective Dec 30, 1998
New Jersey Medicaid has suspended Federal Upper Limits (FUL) for several generic drugs including Amitriptyline, Triavil, Urecholine, Soma, and Serax. Reimbursement will now be based on AWP minus 10% plus dispensing fees, or the provider's usual and customary charge, whichever is lower.
Medium impact
Newsletter Vol. 9, No. 10
New Jersey Medicaid·Identified Jun 20, 2026
This is a provider notice about the New Jersey Vaccines For Children (VFC) Program. Without access to the full document content, the specific changes to billing procedures, coverage, or administrative requirements cannot be determined from the summary alone.
Medium impact
Newsletter Vol. 9, No. 12
New Jersey Medicaid·Effective Jan 1, 1998
New Jersey Medicaid has updated reimbursement rates and procedures for IUD insertion and removal services, introducing new HCPCS codes (W0001, W0002, W0004, W0008) with higher payment rates and requiring specific family planning indicators on claims. The policy also adds anesthesia basic units and 30-day follow-up periods for these procedures.
Medium impact
Newsletter Vol. 9, No. 13
New Jersey Medicaid·Effective Jan 1, 1998
New Jersey Medicaid is updating reimbursement rates for intrauterine device (IUD) insertion and removal services provided by certified nurse midwives, effective January 1, 1998. Providers must now complete Item 24H on HCFA 1500 claims with family planning service indicators (code 2 or 3 for EPSDT) to identify claims properly. Maximum fee allowances have been updated for all IUD-related codes.

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