All Insurance Policy Changes (Page 813)

Continuing from page 812. Showing older policy changes tracked across all payers. Use the filters in the related-hubs section below to narrow by provider, state, or specialty.

High impact
Newsletter Vol. 9, No. 69
New Jersey Medicaid·Effective Dec 1, 1999
Effective December 1, 1999, New Jersey Medicaid is transferring prior authorization (PA) processing for ADD drugs, methadone, protein nutritional supplements, and specialized infant formulas from Medicaid District Offices (MDOs) to First Health Services Corporation (the MEP contractor). Pharmacies must now contact First Health Services at 1-877-888-2939 to request PA for these products; the PA process will be triggered by Edit 535 in the point-of-sale claims system.
Medium impact
Newsletter Vol. 9, No. 70
New Jersey Medicaid·Effective Dec 1, 1999
New Jersey Medicaid requires prior authorization for pharmacy services when beneficiaries exceed 12 prescriptions per month (reducing to 7 over time), effective December 1, 1999. Pharmacists must call First Health Services at 1-877-888-2939 for PA requests when monthly prescription thresholds are exceeded.
Low impact
Newsletter Vol. 9, No. 71
New Jersey Medicaid·Effective Oct 1, 1998
New Jersey Medicaid requires all participating pharmacies to complete and submit a Prospective Drug Utilization Review (PDUR) Certification Statement by December 1, 1999, documenting compliance with OBRA requirements to offer patient consultation on significant medication-related matters. This is a state-mandated compliance reporting requirement for the October 1, 1998 to September 30, 1999 service period.
Low impact
Newsletter Vol. 9, No. 72
New Jersey Medicaid·Effective Oct 28, 1999
Two pharmaceutical manufacturers (Sanofi-Synthelabo and Rising Pharmaceuticals, Inc.) have been added to the New Jersey PAAD (Pharmaceutical Assistance to the Aged and Disabled) Drug Rebate Program. Providers must update their pharmacy systems to recognize these new labeler codes (00955 and 64980) for proper claim processing and drug coverage verification under PAAD.
Medium impact
Newsletter Vol. 9, No. 73
New Jersey Medicaid·Effective Oct 22, 1999
New Jersey Medicaid suspends Federal Upper Limit (FUL) pricing for 8 generic drugs effective October 22, 1999, due to marketplace unavailability. Reimbursement for these drugs will now be based on the lower of AWP minus 10% plus dispensing fee, or the provider's Usual and Customary Charge. This affects erythromycin estolate, folic acid, ibuprofen, lindane, minoxidil, piroxicam, ranitidine hydrochloride, and valproic acid across multiple dosages and package sizes.
Medium impact
Newsletter Vol. 9, No. 74
New Jersey Medicaid·Effective Nov 1, 1999
New Jersey Medicaid now permits off-site partial care/partial hospitalization (PC/PH) mental health services when clinically justified and properly documented. Off-site activities are reimbursable only if they are physician-prescribed, individualized, therapeutic (not recreational), integrated into treatment plans, and limited to less than 10% of a client's annual programming time unless prior authorized. All off-site services require staff supervision, sign-in/sign-out documentation at the clinic, and clear clinical linkage to treatment goals.
High impact
Newsletter Vol. 9, No. 75
New Jersey Medicaid·Effective Oct 1, 1999
New Jersey Medicaid and NJ KidCare reduced maximum fee allowances for 21 specified HCPCS laboratory service codes, effective October 1, 1999, to align with Medicare fee reductions. Billing teams must update their fee schedules and billing systems to reflect the new lower reimbursement amounts for affected laboratory tests.
Low impact
Newsletter Vol. 9, No. 76
New Jersey Medicaid·Effective Dec 28, 1999
This is a Year 2000 (Y2K) readiness notification from New Jersey Medicaid (NJMMIS) informing providers that the state's systems are Y2K compliant and urging providers to ensure their own systems are ready. The policy includes a revised year-end payment schedule for December 1999/January 2000 to minimize Y2K risks, requiring claims to be submitted by December 28, 1999 (electronic) or December 29, 1999 (paper) to be included in the January 5, 2000 payment.
Medium impact
Newsletter Vol. 9, No. 77
New Jersey Medicaid·Identified Jun 20, 2026
The Monthly Prescription Volume Threshold Process has been updated with a revised effective date and new threshold value. This affects when additional prior authorization or review requirements are triggered based on prescription volume.
Medium impact
Medicaid Alert - MA-1999-13
New Jersey Medicaid·Identified Jun 20, 2026
New Jersey Medicaid is requiring testing of Year 2000 Electronic Media Claims (EMC) systems to ensure billing systems can handle date processing for the year 2000. This appears to be a legacy Y2K compliance testing requirement for electronic claims submission.
Low impact
Newsletter Vol. 9, No. 78
New Jersey Medicaid·Effective Feb 21, 1999
This policy adds four new pharmaceutical manufacturers to the New Jersey PAAD (Pharmaceutical Assistance to the Aged and Disabled) Drug Rebate Program. Billing teams must recognize these newly added manufacturer labeler codes (58468, 59291, 63395, 64065) for claim processing and ensure proper coverage determination under PAAD, noting that PAAD coverage may differ from Medicaid coverage for the same drugs.
Low impact
Newsletter Vol. 9, No. 79
New Jersey Medicaid·Identified Jun 20, 2026
This is a Year 2000 readiness disclosure statement from Newsletter Vol. 9, No. 79. It appears to be a legacy administrative notice regarding Y2K compliance rather than a current policy change affecting medical billing operations.
High impact
Newsletter Vol. 9, No. 80
New Jersey Medicaid·Effective Dec 1, 1999
New Jersey Medicaid, NJ KidCare, and WFNJ/GA require dentists and independent clinics to submit renewed general anesthesia permits from the New Jersey State Board of Dentistry to Unisys (the Division Fiscal Agent) by February 3, 2000, via certified mail with return receipt. Claims for general anesthesia services processed after this date will not be reimbursed until the renewed permit is received and on file.
Low impact
Newsletter Vol. 9, No. 81
New Jersey Medicaid·Effective May 28, 1999
New Jersey PAAD program has retroactively activated three manufacturer labeler codes (McNeil Consumer Healthcare, Carlsbad Technology, and InterMune Pharmaceuticals) effective May-June 1999. Providers must resubmit previously denied claims for dates of service on or after the activation dates for these manufacturers' drugs.
Medium impact
Newsletter Vol. 9, No. 82
New Jersey Medicaid·Effective Dec 1, 1999
New Jersey is rescinding a previously announced policy change that would have discontinued Medicaid coverage for HIV/AIDS drugs and required beneficiaries to enroll in a separate AIDS Drug Distribution Program. Providers should continue following current coverage and reimbursement policies for HIV/AIDS medications.
Medium impact
Medicaid Alert - MA-2000-01
New Jersey Medicaid·Identified Jun 20, 2026
New policy clarifies the difference between Medicaid eligibility cards and Families First eligibility identification cards. Billing teams must learn to distinguish between these two types of cards to ensure proper eligibility verification and accurate claim submission.
Medium impact
Newsletter Vol. 10, No. 01
New Jersey Medicaid·Identified Jun 20, 2026
This is a correction newsletter to Vol. 9, No. 57 regarding updates to the HCFA Common Procedure Coding System (HCPCS). The specific corrections or changes are not detailed in the summary provided, requiring review of the full document for implementation details.
High impact
Newsletter Vol. 10, No. 02
New Jersey Medicaid·Effective Oct 1, 1999
New Jersey Medicaid corrected reimbursement rates for 150+ laboratory and pathology HCPCS codes, with most rates decreasing significantly to align with Medicare fee schedules. This correction supersedes the original September 1999 newsletter and affects all lab service billing.
Low impact
Newsletter Vol. 10, No. 03
New Jersey Medicaid·Identified Jun 20, 2026
New manufacturer labeler codes have been added to the PAAD Drug Rebate Program list in Appendix F. This update expands the pharmaceutical manufacturers participating in New Jersey's prescription assistance program for aged and disabled patients.
High impact
Newsletter Vol. 10, No. 04
New Jersey Medicaid·Effective Jan 15, 2000
New Jersey Medicaid is implementing two pharmacy policy changes effective January 15, 2000: (1) reducing the Monthly Prescription Volume Threshold Process (MPTP) limit from 12 to 10 prescriptions per calendar month, and (2) activating maximum daily dosage edits (Edit 535) for pharmaceutical inhalers with a Medical Exception Process (MEP) available for overrides.
Medium impact
Newsletter Vol. 10, No. 05
New Jersey Medicaid·Effective Jan 1, 1999
New Jersey Medicaid and NJ KidCare programs are adding 5 pharmaceutical manufacturers to their drug rebate program (effective 01/01/99) and removing 1 manufacturer. Drugs from deleted manufacturers will no longer be reimbursed. Billing teams must update their approved manufacturer lists to reflect these changes.
Medium impact
Newsletter Vol. 10, No. 06
New Jersey Medicaid·Effective Jan 1, 2000
New Jersey Medicaid and NJ KidCare fee-for-service programs have delisted two pharmaceutical manufacturers (Komax Pharmaceuticals and Care Technologies, Inc.) from their drug rebate programs. Effective immediately, drugs manufactured by these companies will no longer be reimbursed by these programs.
High impact
Newsletter Vol. 10, No. 07
New Jersey Medicaid·Effective Jan 1, 2000
New Jersey Medicaid and NJ KidCare fee-for-service programs are adding six new pharmaceutical manufacturers to their drug rebate program and terminating coverage for six existing manufacturers effective January 1, 2000. Drugs from terminated manufacturers will no longer be reimbursed by these programs.
Medium impact
Newsletter Vol. 10, No. 10
New Jersey Medicaid·Effective Feb 1, 2000
New Jersey is expanding prior authorization (PA) requirements for certain pharmaceutical services to Paterson and Camden city General Assistance (GA) beneficiaries, effective February 1, 2000. Pharmacies must obtain PA approval before dispensing listed drugs and products (including refills), with a 72-hour emergency supply exception. PA requests must be submitted to the hotline at 1-800-609-0106 during business hours (8:30 AM–4:30 PM weekdays).
Medium impact
Medicaid Alert - MA-2000-02
New Jersey Medicaid·Identified Jun 20, 2026
New Medicaid policy provides Q&A guidance for Medical Exception Process (MEP) and Monthly Prescription Volume Threshold Process (MPTP) for pharmacy billing. This clarifies procedures for handling prescription exceptions and volume thresholds under Medicaid pharmacy benefits.

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Newsletter Vol. 9, No. 69

Newsletter Vol. 9, No. 70

Newsletter Vol. 9, No. 71

Newsletter Vol. 9, No. 72

Newsletter Vol. 9, No. 73

Newsletter Vol. 9, No. 74

Newsletter Vol. 9, No. 75

Newsletter Vol. 9, No. 76

Newsletter Vol. 9, No. 77

Medicaid Alert - MA-1999-13

Newsletter Vol. 9, No. 78

Newsletter Vol. 9, No. 79

Newsletter Vol. 9, No. 80

Newsletter Vol. 9, No. 81

Newsletter Vol. 9, No. 82

Medicaid Alert - MA-2000-01

Newsletter Vol. 10, No. 01

Newsletter Vol. 10, No. 02

Newsletter Vol. 10, No. 03

Newsletter Vol. 10, No. 04

Newsletter Vol. 10, No. 05

Newsletter Vol. 10, No. 06

Newsletter Vol. 10, No. 07

Newsletter Vol. 10, No. 10

Medicaid Alert - MA-2000-02