All Insurance Policy Changes (Page 823)

Continuing from page 822. 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. 12, No. 31
New Jersey Medicaid·Effective Jan 1, 2002
New Jersey Medicaid added 11 new HCPCS codes with reimbursement rates effective January 1, 2002, and deleted 5 codes effective June 1, 2002. Mental Health Clinics must use modifier 'ZI' for specific psychological testing codes when billing Medicaid.
Low impact
Newsletter Vol. 12, No. 32
New Jersey Medicaid·Identified Jun 20, 2026
New pharmaceutical manufacturer labeler codes have been added to the New Jersey PAAD (Pharmaceutical Assistance to the Aged and Disabled) Drug Rebate Program list. This update expands the list of approved manufacturers whose drugs are eligible for rebate processing under the state program.
Medium impact
CSOCI Newsletter Vol. 02, No. 04
New Jersey Medicaid·Effective May 1, 2002
This New Jersey policy establishes reimbursement procedures for JCAHO-accredited residential treatment centers (RTCs) when residents are temporarily absent for hospital or therapeutic leave. Providers can bill for up to 14 continuous days of bed reservation per episode using specific HCPCS codes (Y9949, Y9950, Y9951, Y9952). Claims must use HCFA 1500 forms with proper coding, and billing dates cannot span multiple months or mix leave types on the same line.
High impact
Medicaid Alert - MA-2002-06
New Jersey Medicaid·Effective May 1, 2002
New Jersey Medicaid is automatically enrolling Aged, Blind and Disabled (ABD) beneficiaries in Camden County into HMOs starting May 1, 2002. Most prescription drugs will now be managed by HMOs, but certain psychiatric medications and methadone remain covered under fee-for-service Medicaid.
High impact
Medicaid Alert - MA-2002-07
New Jersey Medicaid·Effective May 1, 2002
Effective May 1, 2002, New Jersey Medicaid auto-enrolled all non-dually eligible Aged, Blind, and Disabled (ABD) beneficiaries in Camden County into Medicaid HMOs. Mental health/substance abuse (MH/SA) services for non-DDD clients are now covered fee-for-service and must be billed directly to Medicaid FFS. Specific antipsychotic drugs (Clozapine, Risperidone, Olanzapine, Ziprasidone, Quetiapine) and Methadone are carved out and paid by fee-for-service; lab work related to these medications must also be billed to Medicaid FFS, not HMOs.
Medium impact
Newsletter Vol. 12, No. 33
New Jersey Medicaid·Effective Feb 1, 2002
New Jersey Medicaid/NJ FamilyCare now covers first assistant services performed by qualified Certified Nurse-Midwives at Cesarean deliveries in in-patient hospital settings. Billing teams must use the specified procedure codes with modifiers WM 80 for claims with service dates on or after February 1, 2002. Coverage is limited to hospital-based cesarean deliveries only; other settings are not covered.
High impact
Newsletter Vol. 12, No. 34
New Jersey Medicaid·Effective May 1, 2002
Effective May 1, 2002, New Jersey's Medicaid program will begin auto-assigning Aged, Blind, and Disabled (ABD) beneficiaries who have not voluntarily selected an HMO into mandatory managed care plans, starting in Camden County. Providers must verify HMO network participation to continue serving these patients, as only in-network providers can bill for Medicaid-enrolled beneficiaries.
Medium impact
Newsletter Vol. 12, No. 35
New Jersey Medicaid·Effective Jan 1, 2002
New Jersey Medicaid has implemented a 2.6% Social Security cost of living adjustment (COLA) effective January 1, 2002, which affects patient payment calculations for long-term care facilities. Facilities must review the COLA UPDATE REPORT and update patient payment amounts on their billing documents if the difference is $1.00 or more.
Medium impact
Newsletter Vol. 12, No. 36
New Jersey Medicaid·Identified Jun 20, 2026
This policy notice announces additions and changes to Prior Determination of Utilization Review (PDUR) standards, which typically affects prior authorization requirements for medical services and procedures.
Medium impact
Newsletter Vol. 12, No. 37
New Jersey Medicaid·Effective May 1, 2002
New Jersey expanded coverage under the Supplementary Prenatal Care Program (NJSPCP) to include radiology and laboratory services ordered by clinics (effective May 1, 2002 for dates of service on or after July 1, 2001). Prenatal pharmaceuticals dispensed by clinics or hospitals are now covered. However, this is a limited-funded program that will cease coverage when appropriations are exhausted. Labor and delivery services remain excluded from this program.
Medium impact
Newsletter Vol. 12, No. 38
New Jersey Medicaid·Effective May 11, 2002
New Jersey Medicaid is suspending Maximum Allowable Cost (MAC) pricing for six generic drug products (Captopril/HCTZ combinations, Naproxen Sodium, and Nitrofurantoin) effective May 11, 2002, due to marketplace availability changes. Additionally, MAC prices are being updated for eight branded/generic drugs with new reimbursement rates. Billing teams must update pharmacy claim processing to reflect suspended MAC status and new pricing for affected medications.
High impact
Newsletter Vol. 12, No. 39
New Jersey Medicaid·Effective May 1, 2002
New Jersey implemented the New Jersey Care 2000+ managed care program requiring most Medicaid and NJ FamilyCare beneficiaries to enroll in Medicaid-contracted HMOs. Providers must verify HMO network participation for their patients and ensure they are credentialed with applicable plans. Coverage changes include expanded drug coverage for protease inhibitors and anti-retroviral agents, with specific exclusions for certain NJ FamilyCare populations.
Medium impact
Newsletter Vol. 12, No. 41
New Jersey Medicaid·Effective Mar 27, 2002
New Jersey Medicaid and NJ FamilyCare are adding 9 pharmaceutical manufacturers to their drug rebate programs and removing 3 manufacturers effective on various dates between March and July 2002. Drugs from deleted manufacturers (labeler codes 00144, 11086, 52349) will no longer be reimbursed by these programs as of their effective dates.
High impact
Newsletter Vol. 12, No. 42
New Jersey Medicaid·Effective May 1, 2002
New Jersey hospitals must immediately notify the Division of Medical Assistance & Health Services (DMAHS) of any significant changes to their charge structures or charge ratios used for Medicaid/NJ FamilyCare reimbursement. Failure to disclose changes may result in retroactive claim adjustments, cost-to-charge ratio reductions, and potential recovery of overpayments with interest, penalties, and criminal prosecution.
Medium impact
Newsletter Vol. 12, No. 43
New Jersey Medicaid·Effective May 1, 2002
New Jersey Medicaid/NJFC FFS will deny payments using Error Code 702 when providers bill for both polycarbonate and ultraviolet lens treatments on the same lens. Prior authorization remains required for special optical tints, polycarbonate lenses, and ultraviolet filter lenses when medically indicated. The policy also warns providers that fraudulent billing for lens treatments not rendered will result in criminal/civil penalties.
Medium impact
Newsletter Vol. 12, No. 44
New Jersey Medicaid·Effective Jan 1, 2002
New Jersey Medicaid added CPT code 62318-22 for anesthesiologists to bill daily management of postsurgical epidural pain control, excluding the day of surgery. This allows reimbursement for post-operative pain management services that were previously unbillable.
Low impact
Newsletter Vol. 12, No. 45
New Jersey Medicaid·Effective May 20, 2002
New Jersey PAAD (Pharmaceutical Assistance to the Aged and Disabled) program added Scientific Laboratories, Inc. (Labeler Code 66239) to the Manufacturers' Labeler Codes List effective 5/20/02. This affects drug rebate program coverage and eligibility for PAAD beneficiaries in New Jersey. Billing teams must recognize that PAAD, Medicaid, and Senior Gold programs have different drug coverage based on manufacturer participation.
Medium impact
Newsletter Vol. 12, No. 47
New Jersey Medicaid·Identified Jun 20, 2026
A new newsletter has been published containing a revised list of approved practitioner-administered drugs. This update may affect which medications can be billed and administered in clinical settings.
High impact
Newsletter Vol. 12, No. 48
New Jersey Medicaid·Effective Jun 15, 2002
New Jersey is restructuring NJ FamilyCare benefits for WorkFirst NJ/General Assistance (WFNJ/GA) beneficiaries and childless adults. Effective June 15, 2002, hospital services for WFNJ/GA beneficiaries will be reimbursed through Charity Care instead of fee-for-service, and all such claims will be denied. Effective July 1, 2002, WFNJ/GA beneficiaries transition from HMO managed care to NJFC Plan G (community-based fee-for-service), and eligible childless adults will enroll in Plan H with HMO coverage similar to Plan D.
High impact
CSOCI Newsletter Vol. 02, No. 05
New Jersey Medicaid·Effective Feb 1, 2002
New Jersey's Children's System of Care Initiative (CSOCI) is implementing Care Management Organization (CMO) services in Atlantic/Cape May, Bergen, and Mercer counties effective February 2002. Mental health providers must verify CMO enrollment via REVS/MEVS system before rendering services to children, coordinate care with the assigned CMO, and participate in Individual Service Plan (ISP) meetings. Failure to coordinate with CMOs will impact appropriate reimbursement.
Medium impact
Medicaid Alert - MA-2002-08
New Jersey Medicaid·Effective Jul 1, 2002
Effective July 1, 2002, Medicaid is terminating round-trip procedure codes Y0060 and Y0065 for mobility assistance vehicle (MAV) services. Providers must now bill each leg of a round trip separately using one-way codes A0130 and Y0070 on separate claim lines.
High impact
Newsletter Vol. 12, No. 46
New Jersey Medicaid·Effective Oct 16, 2003
New Jersey Medicaid is implementing HIPAA-compliant electronic transaction standards (837 Version 4010, 835 Version 4010, and NCPDP Version 5.1) with a mandatory compliance deadline of October 16, 2003. All providers submitting electronic claims must upgrade their billing software to HIPAA specifications or face claim rejection. This policy also establishes implementation timelines for additional HIPAA transaction sets (276/277, 270/271, 278, 820, 834, 275) and notifies providers of pending HIPAA privacy and security rule requirements.
High impact
Newsletter Vol. 12, No. 49
New Jersey Medicaid·Effective Jun 1, 2002
New Jersey Medicaid/NJ FamilyCare fee-for-service pharmacy providers must NOT collect co-payments from beneficiaries when other insurance covers the prescription. Instead, providers must bill any outstanding co-payment amounts directly to Unisys (the state fiscal agent) through the point-of-sale system using the appropriate Other Coverage code. This clarifies that co-payments are the state's responsibility, not the beneficiary's.
Medium impact
Newsletter Vol. 12, No. 50
New Jersey Medicaid·Effective Jul 1, 2002
New Jersey has updated its Medicaid and NJ FamilyCare Drug Rebate Programs by adding 4 new pharmaceutical manufacturer labeler codes and removing 3 existing codes. Drugs from deleted manufacturers (3M Pharmaceuticals and PTS Labs) will no longer be reimbursed by these programs starting July 1, 2002.
Medium impact
Newsletter Vol. 12, No. 52
New Jersey Medicaid·Effective Jun 1, 2002
New Jersey Department of Human Services will continue reimbursing drug and alcohol clinics for methadone maintenance services provided to NJ FamilyCare (NJFC) beneficiaries eligible through WorkFirst NJ/General Assistance (WFNJ/GA) using HCPCS code Z2006 at a maximum allowance of $2.50. This reimbursement will continue until the Substance Abuse Initiative (SAI) program becomes available to provide these services. Eligible beneficiaries are identified by specific county codes ('01'-'21'), ID number positions ('70'), and plan designation 'G' on their Medicaid card.

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Newsletter Vol. 12, No. 31

Newsletter Vol. 12, No. 32

CSOCI Newsletter Vol. 02, No. 04

Medicaid Alert - MA-2002-06

Medicaid Alert - MA-2002-07

Newsletter Vol. 12, No. 33

Newsletter Vol. 12, No. 34

Newsletter Vol. 12, No. 35

Newsletter Vol. 12, No. 36

Newsletter Vol. 12, No. 37

Newsletter Vol. 12, No. 38

Newsletter Vol. 12, No. 39

Newsletter Vol. 12, No. 41

Newsletter Vol. 12, No. 42

Newsletter Vol. 12, No. 43

Newsletter Vol. 12, No. 44

Newsletter Vol. 12, No. 45

Newsletter Vol. 12, No. 47

Newsletter Vol. 12, No. 48

CSOCI Newsletter Vol. 02, No. 05

Medicaid Alert - MA-2002-08

Newsletter Vol. 12, No. 46

Newsletter Vol. 12, No. 49

Newsletter Vol. 12, No. 50

Newsletter Vol. 12, No. 52