All Insurance Policy Changes (Page 831)

Continuing from page 830. 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. 13, No. 54
New Jersey Medicaid·Effective Jul 1, 2003
New Jersey now accepts electronic signatures (compliant with the state's UETA Law) in place of handwritten signatures for beneficiary certification in State-covered pharmacy benefits. Pharmacies must continue to display all required certification statements to beneficiaries at point of service when collecting electronic signatures. This is an interim policy effective immediately pending future formal rulemaking.
Medium impact
Newsletter Vol. 13, No. 55
New Jersey Medicaid·Effective Jan 1, 2003
New Jersey Medicaid and NJ FamilyCare updated the list of approved practitioner-administered drugs with three effective dates: (1) One new HCPCS code (Q4053 for Neulasta) added effective July 1, 2003; (2) Reimbursement rates changed for 11 existing drug codes effective January 1, 2003; (3) One code (C9119) deleted effective August 1, 2003 with replacement code Q4053. Billing teams must update fee schedules and code submissions accordingly.
Medium impact
Newsletter Vol. 13, No. 56
New Jersey Medicaid·Effective Jul 1, 2003
New Jersey Medicaid/NJ FamilyCare now allows a billing laboratory within the same corporate structure as a servicing laboratory to bill directly for laboratory services provided by that servicing laboratory. Billing laboratories must report the servicing laboratory's Medicaid provider number on claim forms—either in Field 33 for all services from the servicing lab, or in Field 24K when claims include a mix of services.
Medium impact
Newsletter Vol. 13, No. 57
New Jersey Medicaid·Effective Aug 1, 2003
New Jersey Medicaid and NJ FamilyCare are adding 15 new HCPCS codes for adult, child, and youth-sized incontinence products (diapers and briefs) with maximum fee allowances ranging from $0.50 to $0.90 per unit, effective August 1, 2003. Additionally, two legacy codes (X7520, X7533) are being deleted effective September 30, 2003. Billing teams must implement these new codes in their systems and remove the deleted codes to avoid claim rejections.
Medium impact
Newsletter Vol. 13, No. 58
New Jersey Medicaid·Effective Jul 8, 2003
Effective July 8, 2003, NJ Medicaid/FamilyCare changed reimbursement for ambulance services provided to dually-eligible beneficiaries (those covered by both Medicaid and Medicare). Instead of paying the lower of Medicaid fee or Medicare allowable amount, NJ Medicaid will now pay the GREATER of the two amounts, with a maximum cap at the Medicare allowable amount. This results in increased reimbursement for ambulance providers in most cases.
Low impact
Senior Services News Vol. 7, No. 04
New Jersey Medicaid·Identified Jun 20, 2026
This is a provider notice regarding the distribution of 2004 appropriated funding to nursing facilities with high Medicaid occupancy rates. This appears to be an informational update about funding allocation rather than a billing or coverage policy change.
High impact
Newsletter Vol. 13, No. 59
New Jersey Medicaid·Effective Sep 1, 2003
Effective September 1, 2003, all pharmaceutical services prescribed for Aged, Blind and Disabled (ABD) beneficiaries enrolled in New Jersey Medicaid managed care are now eligible for reimbursement through Medicaid fee-for-service (FFS) rather than through their HMO. Pharmacy claims for these beneficiaries must be submitted to Unisys through the state's point-of-sale system. ABD beneficiaries are identified by specific values (10, 15, 20, 25, 50, 55) in positions 3-4 of their Beneficiary Eligibility Identification number.
High impact
Newsletter Vol. 13, No. 60
New Jersey Medicaid·Effective Aug 24, 2003
New Jersey Medicaid is updating Maximum Allowable Cost (MAC) drug pricing effective August 24, 2003. Five generic drugs have suspended MAC coverage due to unavailable generic versions, while pricing for 13 other drugs has increased and 9 drugs have decreased. Three new drugs have been added to the MAC list with established pricing. Billing teams must update pharmacy claims processing to reflect these new MAC prices and suspension status.
Medium impact
CBHS/PFC/CSOCI Newsletter Vol. 03, No. 03
New Jersey Medicaid·Effective Jan 1, 2004
New Jersey Partnership for Children is introducing two new Medicaid rehabilitation services - Intensive In-Community and Behavioral Assistance Services - effective January 2004. Providers must complete new Medicaid Rehabilitation Provider enrollment and attend mandatory forums in October 2003 to participate.
Medium impact
Newsletter Vol. 13, No. 61
New Jersey Medicaid·Effective Nov 1, 2003
New Jersey FamilyCare Plan H benefit coverage is changing effective November 1, 2003, with specific copay structures and coverage limitations. All restricted alien parents will be enrolled in Plan H and receive the same benefit package.
High impact
Newsletter Vol. 13, No. 62
New Jersey Medicaid·Effective Oct 1, 2003
New Jersey Medicaid and NJ FamilyCare updated their Drug Rebate Program manufacturer lists, adding 5 new pharmaceutical manufacturers effective April-July 2003 and deleting 11 manufacturers effective October 1, 2003. Drugs from deleted manufacturers will not be reimbursed by Medicaid or NJ FamilyCare fee-for-service starting October 1, 2003.
High impact
Newsletter Vol. 13, No. 63
New Jersey Medicaid·Effective Aug 24, 2003
Effective August 24, 2003, New Jersey Medicaid reduced the maximum weekly Personal Care Assistant (PCA) services from 40 hours to 25 hours per beneficiary. Beneficiaries with existing prior authorizations may continue at approved higher levels until expiration. Providers must request new prior authorizations for beneficiaries needing hours exceeding 25 per week, with exemptions available for documented substantial need and waiver program enrollees.
High impact
Newsletter Vol. 13, No. 64
New Jersey Medicaid·Effective Oct 1, 2003
New Jersey mandates prior authorization for brand-name multi-source drugs when generic alternatives exist for Medicaid, NJ FamilyCare, PAAD, Senior Gold, and ADDP beneficiaries. Effective October 1, 2003, prescribers must obtain an authorization number from DMAHS or DHSS before dispensing brand drugs; pharmacies may only dispense a 10-day supply without authorization.
High impact
Newsletter Vol. 13, No. 65
New Jersey Medicaid·Effective Oct 16, 2003
New Jersey Medicaid (DMAHS) is implementing HIPAA-compliant electronic transaction standards for claims, encounters, and remittance advice. Providers must transition to HIPAA 837 format for claims by January 1, 2004, and remittance advice will shift to HIPAA 835 format by the same date. Paper claims remain permitted but electronic submitters must become HIPAA-compliant or risk claim processing delays.
Medium impact
CBHS/PFC/CSOCI Newsletter Vol. 03, No. 04
New Jersey Medicaid·Effective Oct 1, 2003
New Jersey is offering reimbursement for previously denied mental/behavioral health claims for non-Medicaid children enrolled in Partnership for Children (PFC) with ID numbers starting with '3560'. Providers must resubmit original hard copy claims with signed statements by December 31, 2003.
High impact
CBHS/PFC/CSOCI Newsletter Vol. 03, No. 05
New Jersey Medicaid·Effective Oct 1, 2003
Effective October 1, 2003, mental health services provided to non-Medicaid/NJ FamilyCare-eligible children (ID numbers beginning with '3560') who are transitioning out of Care Management Organization services under the Partnership for Children program now require prior authorization numbers from ValueOptions before service delivery. Providers must obtain prior authorization by calling ValueOptions at 1-877-652-7624 and must enter the authorization number in Box #23 of the CMS 1500 claim form or claims will be denied.
Low impact
Medicaid Alert - MA-2003-04
New Jersey Medicaid·Effective Oct 3, 2003
The Passaic Medical Assistance Customer Center has relocated to a new address in Paterson, New Jersey, effective October 3, 2003. Billing teams serving Passaic and Bergen Counties must update all correspondence, payment submissions, and inquiries to use the new address and contact information.
Medium impact
Newsletter Vol. 13, No. 66
New Jersey Medicaid·Identified Jun 20, 2026
The New Jersey PAAD (Pharmaceutical Assistance to the Aged and Disabled) program has added five new pharmaceutical manufacturers to its Drug Rebate Program. Billing teams must recognize these new labeler codes when processing PAAD claims to ensure proper coverage and rebate application for drugs from QOL Medical, Pedinol Pharmacal, Auxilium Pharmaceuticals, Larken Laboratories, and Abrika Pharmaceuticals.
Medium impact
Newsletter Vol. 13, No. 67
New Jersey Medicaid·Effective Jan 1, 2004
Effective January 1, 2004, Pecos Pharmaceutical (Labeler Code 59879) will be deleted from the New Jersey Medicaid and NJ FamilyCare fee-for-service drug rebate programs. All drugs manufactured by this company will no longer be reimbursed by these programs as of that date.
Medium impact
Newsletter Vol. 13, No. 68
New Jersey Medicaid·Effective Nov 2, 2003
New Jersey Medicaid is updating Maximum Allowable Cost (MAC) pricing for multiple pharmaceutical products effective November 2, 2003. Three drugs have MAC suspended (Fluocinolone Acetonide, Pindolol), two drugs have price decreases (Acetaminophen/Propoxyphene Napsylate, Ipratropium Bromide), and two new drugs are added to the MAC list (Aspirin/Butalbital/Caffeine, Lovastatin). Billing teams must update pharmacy reimbursement rates in their systems to avoid claim denials or improper payments.
Low impact
Newsletter Vol. 13, No. 69
New Jersey Medicaid·Identified Jun 20, 2026
This is a provider notice referencing Form FD-70, Pharmacy Provider Certification Statement with a revision date of October 2003. The policy appears to be informational regarding pharmacy provider certification requirements, but specific details about changes or requirements are not provided in the summary.
Low impact
Newsletter Vol. 13, No. 70
New Jersey Medicaid·Effective Oct 1, 2002
New Jersey Medicaid is requiring pharmacies to complete and submit a Prospective Drug Utilization Review (PDUR) Certification Statement documenting compliance with patient consultation requirements for pharmaceutical services provided October 1, 2002 through September 30, 2003. Pharmacies must certify that they consistently offered to consult with Medicaid beneficiaries on significant drug utilization matters and provide percentage breakdowns of consultations accepted, refused, and deemed insignificant.
High impact
Medicaid Alert - MA-2003-05
New Jersey Medicaid·Effective Jul 1, 2003
New Jersey Medicaid adopted CDT4 dental procedure codes effective July 1, 2003, replacing previous CDT3 and legacy codes. Dental providers must now report CDT4 codes for all services provided on or after this date, with the Unisys claims processing system automatically matching new codes to previously authorized procedures. The alert provides FAQs on code usage, common billing errors, and contact procedures for prior authorization corrections and claim denials.
Medium impact
Newsletter Vol. 13, No. 71
New Jersey Medicaid·Effective Nov 1, 2003
New Jersey Medicaid and NJ FamilyCare will now reimburse for antiretroviral resistance testing (genotype, phenotype, and virtual phenotype) for HIV patients, with specific fee schedules and a limit of three tests per 12-month period. Providers must complete and maintain a specific criteria checklist in patient medical records.
High impact
Newsletter Vol. 13, No. 72
New Jersey Medicaid·Effective Oct 22, 2003
New Jersey Medicaid is transitioning pharmacy remittance advice (RA) statements from the current Unisys format to the HIPAA 835 RA format. Effective immediately for claims with payment dates on or after October 22, 2003, pharmacies can opt into the new format; however, the old format will be discontinued entirely on or about January 1, 2004, at which point all electronic RAs will use only the HIPAA 835 format. Additionally, only HIPAA-approved error codes will appear on the new electronic statements, and claim submission formats are changing to NCPDP Version 5.1 and 1.1 for service dates on or after January 1, 2004.

Browse by payer Browse by state Browse by specialty Browse by billing code Browse & filter all changes

Get alerts for changes like this

Save a search and receive a daily digest whenever a new policy change matches your filters.

Create a free alert

Archive by year

2023 2024 2025 2026

Newsletter Vol. 13, No. 54

Newsletter Vol. 13, No. 55

Newsletter Vol. 13, No. 56

Newsletter Vol. 13, No. 57

Newsletter Vol. 13, No. 58

Senior Services News Vol. 7, No. 04

Newsletter Vol. 13, No. 59

Newsletter Vol. 13, No. 60

CBHS/PFC/CSOCI Newsletter Vol. 03, No. 03

Newsletter Vol. 13, No. 61

Newsletter Vol. 13, No. 62

Newsletter Vol. 13, No. 63

Newsletter Vol. 13, No. 64

Newsletter Vol. 13, No. 65

CBHS/PFC/CSOCI Newsletter Vol. 03, No. 04

CBHS/PFC/CSOCI Newsletter Vol. 03, No. 05

Medicaid Alert - MA-2003-04

Newsletter Vol. 13, No. 66

Newsletter Vol. 13, No. 67

Newsletter Vol. 13, No. 68

Newsletter Vol. 13, No. 69

Newsletter Vol. 13, No. 70

Medicaid Alert - MA-2003-05

Newsletter Vol. 13, No. 71

Newsletter Vol. 13, No. 72