All Insurance Policy Changes (Page 841)

Continuing from page 840. 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
Senior Services News Vol. 12, No. 01
New Jersey Medicaid·Effective Aug 1, 2009
Effective August 1, 2009, the PAAD and Senior Gold prescription programs will no longer cover Medicare Part D-excluded drugs (except benzodiazepines and barbiturates), including erectile dysfunction treatments, cosmetic drugs, cough/cold products, and vitamins. Additionally, PAAD/SG will only provide wrap-around coverage for Medicare Part D formulary medications; beneficiaries must switch to formulary drugs or obtain a formulary exception. Drug reimbursement is now calculated as the lower of AWP minus 16% or the MAC price.
Medium impact
Newsletter Vol. 19, No. 39
New Jersey Medicaid·Effective Aug 1, 2009
A new HMO, Healthfirst Health Plan of New Jersey, will begin serving NJ FamilyCare/Medicaid clients in five counties starting August 1, 2009. Providers can join their network by calling the provided number, expanding Medicaid managed care options in the state.
High impact
Newsletter Vol. 19, No. 40
New Jersey Medicaid·Effective Jul 1, 2009
New Jersey Medicaid HMOs will now cover all nursing facility services (skilled, custodial, rehabilitation, and post-acute care) for the first 30 days of admission for NJ FamilyCare A enrollees, instead of the previous fee-for-service billing. After 30 days, billing reverts to fee-for-service except for hospice care which remains HMO responsibility.
High impact
Newsletter Vol. 19, No. 41
New Jersey Medicaid·Effective Jun 13, 2009
New Jersey Medicaid updated Maximum Allowable Cost (MAC) drug pricing effective June 13 and July 17, 2009. Two generic drugs (Erythromycin 2% topical solution and Verapamil 40 mg tablet) were suspended from the MAC list. Multiple drugs received price increases (Carbamazepine, Isosorbide Mononitrate, Lactulose, Propranolol), price decreases (Cilostazol, Meloxicam, Meperidine, Metformin, Mirtazapine, Tramadol, Atenolol, and others), and new extended-release formulations were added (Metformin ER, Topiramate).
Medium impact
Newsletter Vol. 19, No. 42
New Jersey Medicaid·Effective Aug 1, 2009
New Jersey Medicaid has implemented procedural changes for scheduling non-emergency medical transportation through LogistiCare. Nursing and assisted living facilities must now use LogistiCare's dedicated facility phone line (1-866-527-9945) or fax service to schedule transportation for eligible NJFC/Medicaid clients, and must complete Medical Necessity Forms for each resident requiring transportation.
High impact
Newsletter Vol. 19, No. 43
New Jersey Medicaid·Effective Aug 3, 2009
New Jersey is implementing a new Medicaid fee-for-service reimbursement methodology for hospital inpatient services, moving from hospital-specific DRG rates based on 1988 costs to a statewide base rate system with updated DRG weights. Physicians must now bill separately for inpatient services under their own Medicaid provider numbers instead of being included in hospital payments.
High impact
Newsletter Vol. 19, No. 44
New Jersey Medicaid·Identified Jun 20, 2026
New Jersey Medicaid (NJFC) requires physician-administered drug claims to include specific NDC formatting with 11-digit drug codes, metric quantities, and 2-digit unit of measure qualifiers in designated claim fields. Claims missing or incorrectly reporting this information will be denied. This change ensures compliance with Federal drug rebate regulations (42 CFR 447.520).
High impact
Newsletter Vol. 19, No. 45
New Jersey Medicaid·Effective Jul 1, 2009
Effective July 1, 2009, New Jersey requires prior authorization for all partial care mental health services provided by independent clinics to NJ FamilyCare/Medicaid clients aged 18 and older. New admissions receive a 30-day grace period for assessment completion, after which FD-07 and FD-07A prior authorization forms must be submitted. Authorization periods cannot exceed 180 days, and initial service units are capped at 520 units.
High impact
Newsletter Vol. 19, No. 46
New Jersey Medicaid·Effective Sep 9, 2009
New Jersey is expanding its Drug Utilization Review program to apply First Data Bank (FDB) daily dosage standards to ALL prescription drugs effective September 9, 2009. Claims exceeding these standards will be denied with Error Code 537 or 2100, requiring prior authorization from the physician and Unisys MEP Unit. Medicare Part D claims are exempt from these standards.
Medium impact
Newsletter Vol. 19, No. 47
New Jersey Medicaid·Effective Aug 28, 2009
New Jersey Medicaid has updated Maximum Allowable Cost (MAC) pricing for several generic drugs, removing Desipramine Hydrochloride from MAC limits and adding 16 other generic medications with new pricing tiers. These changes affect Medicaid reimbursement rates for pharmaceutical services.
High impact
Newsletter Vol. 19, No. 48
New Jersey Medicaid·Effective Sep 25, 2009
New Jersey Medicaid revised Maximum Allowable Cost (MAC) pricing for pharmaceutical services effective September 25, 2009. Two drugs had MAC suspended due to generic unavailability, 15 drugs received price decreases, and 4 new drug products were added to the Federal Upper Limits. Billing teams must update drug pricing tables and reimbursement systems immediately.
Medium impact
Newsletter Vol. 19, No. 49
New Jersey Medicaid·Effective Sep 1, 2009
New Jersey is discontinuing Error Code 607 (Low Variance Error) for pharmacy claims and replacing it with Error Code 2099 (Incorrect Unit of Measure Reported for Drug). Pharmacies must now ensure the correct Unit of Measure (EA, GM, or ML) is reported in Field 600-28 of NCPDP 5.1 claims. When Error Code 2099 posts, pharmacists must adjust metric quantity based on the system-reported correct unit of measure.
Medium impact
Senior Services News Vol. 12, No. 02
New Jersey Medicaid·Identified Jun 20, 2026
Medicare suppliers must now provide their Medicare supplier number when billing for certain services. This appears to be a requirement for proper claim processing and reimbursement from Medicare.
Low impact
Newsletter Vol. 19, No. 51
New Jersey Medicaid·Effective Sep 26, 2009
New Jersey Medicaid will maintain pre-settlement pharmacy reimbursement rates through June 30, 2010, despite AWP lawsuit settlement changes that took effect September 26, 2009. Pharmacies will continue receiving the same payment levels as before the settlement during this transition period.
Medium impact
Medicaid Alert - MA-2009-04
New Jersey Medicaid·Effective Oct 1, 2009
New Jersey Medicaid is establishing reimbursement rates and billing codes for H1N1 influenza vaccine administration through the Vaccines for Children (VFC) program. Billing teams must use specific HCPCS codes (G9141 for injection, G914152 for nasal spray) with corresponding reimbursement rates ($11.50 and $5.00 respectively) for Medicaid/NJ FamilyCare fee-for-service beneficiaries. This policy is effective immediately.
High impact
Newsletter Vol. 19, No. 50
New Jersey Medicaid·Effective Nov 1, 2009
New Jersey Medicaid requires hospitals and freestanding ESRD facilities to report the 11-digit National Drug Code (NDC), unit of measure (UOM), and metric quantity for all outpatient-administered drugs on claims, effective November 1, 2009. This federal requirement ensures proper drug rebate billing and claim validation. Claims submitted without complete NDC and UOM information will be denied.
High impact
Newsletter Vol. 19, No. 52
New Jersey Medicaid·Effective May 1, 2009
New Jersey Medicaid is changing hospice reimbursement methodology from provider-based pricing to point-of-service (place of care) pricing effective May 1, 2009. Billing for hospice codes T2042, T2043, T2044, and T2045 now depends on the beneficiary's geographic location and residence type (home, SNF, hospital) rather than the provider's office location. Specific place of service codes and referring provider information requirements have changed based on care setting.
High impact
Newsletter Vol. 19, No. 53
New Jersey Medicaid·Effective Oct 26, 2009
New Jersey Medicaid has updated Federal Upper Limits (FUL) for maximum allowable cost (MAC) drugs, effective October 26, 2009. Multiple generic medications have reduced reimbursement rates, and two new drug products (Bicalutamide and Cephalexin suspension) have been added to the MAC formulary. Billing teams must update pharmacy billing systems to reflect these new MAC prices to avoid claim denials or payment adjustments.
Medium impact
Newsletter Vol. 19, No. 54
New Jersey Medicaid·Effective Nov 1, 2009
New Jersey Medicaid/NJ FamilyCare now reimburses operating room costs for outpatient hospital dental services provided to clients with developmental disabilities or traumatic brain injuries. Operating room charges must be billed using the hospital's Acute Care provider number (with ICD-9 surgical procedure codes), while dental services continue to be billed using the Dental provider number on the existing dental fee schedule.
High impact
Newsletter Vol. 19, No. 55
New Jersey Medicaid·Effective Nov 4, 2009
New Jersey Medicaid (NJFC), PAAD, and Senior Gold programs will deny pharmacy claims that do not include a valid National Provider Identifier (NPI) with Prescriber ID Qualifier '01' to identify the prescriber. Pharmacy claims using Qualifiers '05' and '08' will be denied unless the prescriber is an 'excluded entity' (does not submit claims electronically) and has registered with the Unisys Medical Exception Process Unit.
High impact
Newsletter Vol. 19, No. 56
New Jersey Medicaid·Effective Nov 1, 2009
NJ Medicaid/NJ FamilyCare has revised claim completion and reimbursement procedures for secondary claims where Medicare or third-party insurance is primary. Billing teams must now use specific value codes (A1, A2, A7, B1, B2, B7, C1, C2, C7, A3, B3, C3) in UB-04 form locators 39-41 to indicate deductibles, coinsurance, co-pays, and exhausted benefits. Reimbursement will be calculated as the lesser of the Medicaid allowed amount minus prior payments or the patient liability.
Medium impact
Newsletter Vol. 19, No. 57
New Jersey Medicaid·Identified Jun 20, 2026
New prior authorization requirements have been established for dental encounter visits associated with dental services. This policy specifically affects medical practices that provide dental-related services and requires prior authorization approval before rendering certain dental services.
Low impact
Newsletter Vol. 19, No. 58
New Jersey Medicaid·Effective Jan 15, 2010
New Jersey pharmacy providers must submit Form FD-70 (Pharmacy Provider Certification Statement) by January 15, 2010 to qualify for optional dispensing fee increments for NJ FamilyCare/Medicaid, PAAD, Senior Gold, ADDP, and CF programs. Failure to submit will result in basic dispensing fees only.
Medium impact
Newsletter Vol. 20, No. 01
New Jersey Medicaid·Effective Jan 1, 2010
New Jersey Medicaid has added new dental procedure codes, revised prior authorization requirements for periodontal services and denture rebasing, and updated frequency limits for prophylaxis and orthodontic assessments.
Medium impact
Newsletter Vol. 20, No. 03
New Jersey Medicaid·Effective Mar 1, 2010
University Health Plans, Inc. (UHP) is transferring its New Jersey Medicaid and NJ FamilyCare members to AMERIGROUP New Jersey, Inc. effective March 1, 2010. Former UHP members must select a new HMO by February 10, 2010, or will be automatically assigned to AMERIGROUP. Billing teams must update patient records and ensure claims are submitted to the correct managed care plan.

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Senior Services News Vol. 12, No. 01

Newsletter Vol. 19, No. 39

Newsletter Vol. 19, No. 40

Newsletter Vol. 19, No. 41

Newsletter Vol. 19, No. 42

Newsletter Vol. 19, No. 43

Newsletter Vol. 19, No. 44

Newsletter Vol. 19, No. 45

Newsletter Vol. 19, No. 46

Newsletter Vol. 19, No. 47

Newsletter Vol. 19, No. 48

Newsletter Vol. 19, No. 49

Senior Services News Vol. 12, No. 02

Newsletter Vol. 19, No. 51

Medicaid Alert - MA-2009-04

Newsletter Vol. 19, No. 50

Newsletter Vol. 19, No. 52

Newsletter Vol. 19, No. 53

Newsletter Vol. 19, No. 54

Newsletter Vol. 19, No. 55

Newsletter Vol. 19, No. 56

Newsletter Vol. 19, No. 57

Newsletter Vol. 19, No. 58

Newsletter Vol. 20, No. 01

Newsletter Vol. 20, No. 03