All Insurance Policy Changes (Page 808)

Continuing from page 807. Showing older policy changes tracked across all payers. Use the filters in the related-hubs section below to narrow by provider, state, or specialty.

Low impact
Newsletter Vol. 10, No. 39
New Jersey Medicaid·Effective Dec 1, 1999
New Jersey is implementing the Medical Exception Process (MEP) for prescription drug utilization review across multiple state assistance programs (Medicaid, NJ KidCare, PAAD, ADDP, CF). Providers must inform Spanish-speaking beneficiaries of this process through posted materials. The MEP monitors medication duration, daily consumption, and drug interactions, with First Health Services conducting reviews and contacting physicians when necessary. Medically necessary medications will continue to be covered.
Medium impact
Newsletter Vol. 10, No. 40
New Jersey Medicaid·Effective May 1, 2000
New Jersey Medicaid has transferred responsibility for prior authorization of Mobility Assistance Vehicle (MAV) services for Hudson County beneficiaries from the Passaic County office to the Hudson County Medicaid District Office. Providers must now submit PA requests to Ellen Keane at the Hudson MDO using the new contact information provided.
Low impact
Newsletter Vol. 10, No. 42
New Jersey Medicaid·Effective Mar 15, 2000
The New Jersey PAAD (Pharmaceutical Assistance to the Aged and Disabled) program has added two new pharmaceutical manufacturers to its Drug Rebate Program: Ligand Pharmaceuticals (labeler code 64365, effective 04/13/00) and Womens Capital Corporation (labeler code 64836, effective 03/15/00). Providers must recognize these new labeler codes when processing PAAD pharmacy claims, as coverage may differ between Medicaid and PAAD programs based on manufacturer participation.
High impact
Newsletter Vol. 10, No. 41
New Jersey Medicaid·Effective Apr 17, 2000
New Jersey Medicaid and NJ KidCare fee-for-service programs are adding 5 pharmaceutical manufacturers to their approved rebate drug list and removing 9 manufacturers effective immediately. Drugs from deleted manufacturers will no longer be reimbursed. Billing teams must update their pharmacy benefit management systems to reflect these manufacturer labeler code changes to avoid claim denials.
Medium impact
Newsletter Vol. 10, No. 43
New Jersey Medicaid·Effective Jul 1, 2000
Work First New Jersey/General Assistance (WFNJ/GA) beneficiaries with HIV/AIDS must now enroll in the AIDS Drug Distribution Program (ADDP) for antiretroviral medications. WFNJ/GA will no longer cover certain HIV/AIDS drugs, which will be covered through ADDP instead.
Medium impact
Newsletter Vol. 10, No. 44
New Jersey Medicaid·Effective Jul 1, 2000
Effective July 1, 2000, Work First New Jersey/General Assistance (WFNJ/GA) beneficiaries diagnosed with HIV/AIDS must enroll in the AIDS Drug Distribution Program (ADDP) to receive coverage for antiretroviral and related HIV/AIDS drugs. WFNJ/GA is discontinuing direct coverage for these medications, which will now be provided through ADDP. Pharmacies must submit denied WFNJ/GA claims for ADDP-eligible drugs using the beneficiary's ADDP eligibility number, and Error Code 402 will flag non-covered drugs eligible for ADDP coverage.
High impact
Newsletter Vol. 10, No. 45
New Jersey Medicaid·Effective Jun 15, 2000
New Jersey's PAAD program is implementing Prospective Drug Utilization Review (PDUR) monitoring based on duration of therapy standards for specified medications effective June 15, 2000. Pharmacists will receive Error Code 403 when duration limits are exceeded and must contact First Health Services for prior authorization. Claims exceeding duration periods will be denied with Error Code 404, requiring resubmission with adjusted quantities.
Low impact
Newsletter Vol. 10, No. 46
New Jersey Medicaid·Effective May 25, 2000
New Jersey added Virco Pharmaceuticals (labeler code 65199) to the PAAD Drug Rebate Program effective May 25, 2000. This allows PAAD-eligible patients to receive rebated pricing on Virco pharmaceutical products.
Medium impact
Newsletter Vol. 10, No. 48
New Jersey Medicaid·Effective Jul 1, 2000
Effective July 1, 2000, Work First New Jersey/General Assistance (WFNJ/GA) beneficiaries diagnosed with HIV/AIDS must enroll in the AIDS Drugs Distribution Program (ADDP) for coverage of specific antiretroviral medications. During the enrollment transition period, pharmacies should continue receiving reimbursement for ADDP-covered HIV/AIDS drugs, and Error Code 402 will be converted to an informational message directing patients to enroll in ADDP rather than denying claims.
High impact
Newsletter Vol. 10, No. 47
New Jersey Medicaid·Effective Sep 1, 2000
New Jersey Medicaid, GA, and NJ KidCare now require pharmacies to submit pharmaceutical claims to other insurance carriers BEFORE submitting to the state programs, and to report all third-party payments on claims. Claims with service dates on or after September 1, 2000 that have third-party coverage on file will be denied unless third-party payment amounts are reported using NCPDP field 431 (Other Payer Amount) or MC-6 form fields. Non-participating pharmacies must obtain prior authorization from First Health Services when serving beneficiaries in non-participating networks.
Low impact
Newsletter Vol. 10, No. 49
New Jersey Medicaid·Effective Sep 30, 1999
New Jersey has added Sanofi-Synthelabo (labeler code 08024) to the PAAD Drug Rebate Program for pharmaceutical providers. This addition was effective September 30, 1999, and affects prescription drug billing for aged and disabled patients in New Jersey's PAAD program.
Medium impact
Newsletter Vol. 10, No. 50
New Jersey Medicaid·Effective Aug 1, 2000
New Jersey Medicaid and related programs are updating their Maximum Allowable Cost (MAC) drug payment limits effective August 1, 2000, based on revised Federal upper limits from HCFA. Providers and HMOs must replace the previous MAC drug list (Rev. 10/98) with the new revised list (Rev. 8/1/2000) in their Pharmaceutical Services Manual to ensure accurate reimbursement for covered drugs.
High impact
Newsletter Vol. 10, No. 51
New Jersey Medicaid·Effective Jul 1, 2000
New Jersey is updating Average Wholesale Price (AWP) calculations for certain prescription drugs effective July 1, 2000, based on First Data Bank's revised market-based pricing methodology. Reimbursement for Medicaid, GA, PAAD, ADDP, and CF pharmacy claims will now be based on the lower of the pharmacy's usual and customary charge or AWP plus a dispensing fee of $3.73–$4.07, with MAC pricing continuing to apply where appropriate.
Medium impact
Newsletter Vol. 10, No. 53
New Jersey Medicaid·Effective Aug 1, 2000
New Jersey Medicaid updated their Prospective Drug Utilization Review (PDUR) program with changes to maximum daily dosage standards for rabeprazole and zaleplon, deleted certain therapeutic duplication conflicts, and limited Synagis injection coverage to children under 2 years old.
High impact
Newsletter Vol. 10, No. 54
New Jersey Medicaid·Effective Sep 1, 2000
Effective September 1, 2000, New Jersey Medicaid and NJ KidCare FFS programs will only reimburse Medicare-covered prescription drugs and diabetic materials when supplied by pharmacies enrolled as Medicare-approved medical supply providers. Non-participating pharmacies must submit these claims as crossover claims through Medicare first, or request prior authorization if no alternative provider exists within 5 miles. Claims submitted by non-Medicare-approved pharmacies will be denied.
Medium impact
Newsletter Vol. 10, No. 55
New Jersey Medicaid·Effective Jul 1, 2000
New Jersey Medicaid/NJ KidCare now reimburses emergency contraceptive services using two new HCPCS codes (Z4333 for Preven kit at $19.94 and Z4334 for Plan B kit at $10.98). Providers must identify claims as family planning services by completing the family planning indicator field on claim forms to receive reimbursement.
Medium impact
Newsletter Vol. 10, No. 56
New Jersey Medicaid·Effective Aug 1, 2000
New Jersey is discontinuing prior authorization processing for a specific list of drugs for Work First New Jersey/General Assistance (WFNJ/GA) beneficiaries in Newark, East Orange, Camden City, and Trenton. These drugs will now be monitored through the Medical Exception Process (MEP) and Monthly Prescription Volume Threshold Process (MPTP) instead.
Medium impact
Newsletter Vol. 10, No. 57
New Jersey Medicaid·Identified Jun 20, 2026
New Jersey requires mandatory lead screening for all children aged 9-12 months and 2 years, with annual risk assessments from age 6 months to 6 years. Capillary blood tests ≥10 ug/dL must be confirmed with venous samples. Providers must use preventive health visits for lead risk assessment and refer children under 5 to WIC for nutritional counseling.
Medium impact
Medicaid Alert - MA-2000-06
New Jersey Medicaid·Identified Jun 20, 2026
New Medicaid billing procedures have been established for dental services covered under Medicaid programs. This policy provides updated guidance on proper coding and billing requirements for dental procedures to ensure compliance and avoid claim denials.
Medium impact
Newsletter Vol. 10, No. 52
New Jersey Medicaid·Identified Jun 20, 2026
New Jersey Medicaid Fee-For-Service has updated allowable rates for dental services. This affects reimbursement amounts for dentist services billed to NJ Medicaid FFS plans.
Medium impact
Newsletter Vol. 10, No. 58
New Jersey Medicaid·Effective Aug 1, 2000
New Jersey Medicaid is establishing reimbursement guidelines for adult male-specific family planning services effective August 1, 2000. Billing teams must use three specific HCPCS codes with modifier WF (99201 WF for initial visits, 99211 WF for follow-ups, 99395 WF for annual visits) and complete the family planning indicator field on all claims. All service components must be rendered to qualify for reimbursement, and claims must include the appropriate family planning code indicator ("2" or "3") on HCFA 1500 forms or condition code A-4 on UB-92 forms.
High impact
Newsletter Vol. 10, No. 59
New Jersey Medicaid·Effective Jul 12, 2000
New Jersey Medicaid and NJ KidCare programs have added 5 pharmaceutical manufacturers to their drug rebate program (effective 07/12/2000) and removed 6 manufacturers from coverage. Drugs from deleted manufacturers will no longer be reimbursed by these programs.
Medium impact
Newsletter Vol. 10, No. 60
New Jersey Medicaid·Effective Aug 1, 2000
New prior authorization requirements for Somatropin (human growth hormone) injections effective August 1, 2000. Initial claims require First Health prior auth for a 14-day supply; subsequent authorizations can cover up to 12 weeks. All claims remain subject to the 75% early refill rule. Billing teams must obtain prior authorization before dispensing to avoid claim denials.
Low impact
Newsletter Vol. 10, No. 61
New Jersey Medicaid·Effective Aug 1, 2000
New Jersey has rescinded Newsletter Volume 10, No. 50 from July 2000 that would have updated Maximum Allowable Cost (MAC) drug reimbursement rates. Pharmacy providers should continue using the previous reimbursement rates from December 1998 until further notice.
Medium impact
Newsletter Vol. 10, No. 63
New Jersey Medicaid·Effective Aug 1, 2000
New Jersey Medicaid increased maximum allowable fees for case management services effective August 1, 2000 for three waiver programs: Model Waivers 1/2/3 ($115.00), ACCAP ($125.00), and TBI Waiver ($135.00). Billing teams must update fee schedules and billing systems to reflect these new maximum rates for claims with service dates on or after August 1, 2000.

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Newsletter Vol. 10, No. 57

Medicaid Alert - MA-2000-06

Newsletter Vol. 10, No. 52

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Newsletter Vol. 10, No. 63