All Insurance Policy Changes (Page 846)

Continuing from page 845. 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. 23, No.12
New Jersey Medicaid·Effective Jan 1, 2013
New Jersey Medicaid now provides enhanced reimbursement rates (based on 2013 Medicare Fee Schedule) for Evaluation & Management (E&M) and vaccine administration services provided by Advanced Practice Nurses (APNs) in qualified physician group practices specializing in family medicine, internal medicine, or pediatrics. APNs must be personally supervised by an eligible physician, and the supervising physician must complete and submit an updated ACA Self-Attestation Form (ATT-06/10/2013) by September 1, 2013 for retroactive payment eligibility dating back to January 1, 2013.
Medium impact
Newsletter Vol. 23, No.04
New Jersey Medicaid·Identified Jun 20, 2026
This policy notice contains revisions to the Affordable Care Act (ACA) provisions as amended by the Health Care and Education Reconciliation Act of 2010, with enhanced reimbursement rates. The summary-only format limits detailed analysis, but this appears to involve payment rate improvements.
Medium impact
Newsletter Vol. 23, No.13
New Jersey Medicaid·Effective Aug 1, 2013
New Jersey Medicaid immediately discontinued coverage of active pharmaceutical ingredients (APIs) and excipients used in compound prescriptions. Pharmacies can no longer bill Medicaid for these bulk substances but can charge patients directly for non-covered ingredients.
High impact
Newsletter Vol. 23, No.15
New Jersey Medicaid·Effective Sep 1, 2013
New Jersey Medicaid/NJ FamilyCare has reiterated its strict prohibition on balance billing beneficiaries. Providers must accept Medicaid payments as payment in full and cannot bill patients for any additional charges, except in very specific circumstances requiring written patient consent and meeting multiple criteria.
Medium impact
Newsletter Vol. 23, No.16
New Jersey Medicaid·Effective Jan 1, 2013
New Jersey Medicaid now requires social workers (LCSWs, LSWs, CSWs) who refer patients to enroll as 'non-billing' providers and obtain NPIs. Billing providers must include the social worker's NPI on claims for referred services to receive payment.
Medium impact
Newsletter Vol. 23, No.17
New Jersey Medicaid·Identified Jun 20, 2026
A recent newsletter announces payment of enhanced physician reimbursement rates for 2013. This appears to be a reimbursement rate update that could affect payment amounts for medical services.
High impact
Medicaid Alert - MA2013-01
New Jersey Medicaid·Effective Jan 1, 2014
New Jersey Medicaid requires hospice providers to use specific state-mandated forms (FD-378 through FD-385) for all beneficiaries electing hospice benefits on or after January 1, 2014. Forms must be submitted to the Medicaid office of supervision and/or included in the beneficiary's medical record. Non-compliance will result in fund recovery and sanctions.
Medium impact
Newsletter Vol. 23, No.18
New Jersey Medicaid·Effective Sep 1, 2013
New Jersey Medicaid clarified billing procedures for mental health and substance abuse services, specifying which CPT codes and modifiers each provider type can use. Independent mental health clinics can bill psychiatric diagnostic evaluations and psychotherapy codes with specific modifiers, while SAI and Non-SAI substance abuse providers have more limited code sets with different modifier requirements.
Low impact
Senior Services News Vol. 16, No. 02
New Jersey Medicaid·Effective Jan 1, 2014
New Jersey updated income eligibility limits for pharmaceutical assistance programs (PAAD, Lifeline, HAAAD, and Senior Gold) effective January 1, 2014, with a 1.5% increase based on Social Security COLA. PAAD eligibility is now less than $26,130 for single persons and less than $32,037 for married couples, while Senior Gold ranges are $26,130-$36,130 for singles and $32,037-$42,037 for married couples.
High impact
Newsletter Vol. 23, No.19
New Jersey Medicaid·Identified Jun 20, 2026
This policy update provides a comprehensive review of billing procedures specifically for anesthesia services. Given that this is a fresh 1-day-old policy, it likely contains important updates or clarifications that anesthesia providers and billing teams need to implement immediately.
High impact
Newsletter Vol. 23, No.21
New Jersey Medicaid·Effective Dec 1, 2013
New Jersey Medicaid now allows telepsychiatry services (psychiatric care via secure videoconference) to be billed as face-to-face mental health services when provided by psychiatrists or psychiatric advance practice nurses. Mental health clinics must bill under their own Medicaid provider number using existing outpatient codes (hospitals) or HCPCS codes with GT modifier (independent clinics), and must establish and obtain DMAHS approval for policies addressing 14 specific operational and technical requirements before providing services.
High impact
Newsletter Vol. 23, No.20
New Jersey Medicaid·Effective Jan 1, 2014
New Jersey FamilyCare (NJFC) program expands effective January 1, 2014 to cover parents, single adults, and childless couples ages 19-64 at up to 133% Federal Poverty Level under a new Alternative Benefit Plan (ABP). The ABP replaces NJFC Plan G and Plan D for these populations and includes expanded mental health, substance abuse, and family planning services. Key differences: ABP beneficiaries have zero co-payments, mental health/substance abuse services are paid fee-for-service by NJFC regardless of HMO enrollment, and Error Code 380 will continue denying FFS claims that must route to HMOs.
High impact
Newsletter Vol. 24, No.01
New Jersey Medicaid·Effective Apr 1, 2014
New Jersey Medicaid is mandating transition from the 1500 (08/05) claim form to the 1500 (02-12) form effective April 1, 2014. The new form accommodates ICD-10 codes, adds an ICD indicator field, supports up to 12 diagnosis codes (vs. 7), and changes provider ID qualifiers from '1D' to 'G2'. Claims submitted on the old form after March 31, 2014 will be rejected.
High impact
Newsletter Vol. 24, No.02
New Jersey Medicaid·Effective Jul 1, 2014
Effective July 1, 2014, NJ FamilyCare Plans B, C, and D will no longer have access to free vaccines through the NJ-VFC program. Providers must now obtain vaccines from traditional market sources and bill the managed care plans for both vaccine costs and administration fees. Only Plan A and Medicaid-eligible children retain NJ-VFC access.
High impact
Newsletter Vol. 24, No.03
New Jersey Medicaid·Effective Jan 1, 2014
New Jersey expanded NJ FamilyCare (NJFC) coverage effective January 1, 2014 to include mental health and substance abuse services for parents, single adults, and childless couples earning up to 133% of Federal Poverty Level under a new Alternative Benefit Plan (ABP). Billing teams must implement new HCPCS/CPT procedure codes with specific modifiers and fee allowances for substance abuse treatment, psychiatric emergency services, and behavioral health services. All ABP mental health and substance abuse claims are paid fee-for-service regardless of managed care enrollment, and beneficiaries have zero co-payment responsibility for these covered services.
Medium impact
Newsletter Vol. 24, No.04
New Jersey Medicaid·Effective Jun 1, 2014
New Jersey FamilyCare (NJ Medicaid) requires re-enrollment of all fee-for-service providers enrolled before January 1, 2013, starting June 1, 2014. Institutional providers must pay a $542 application fee, while non-institutional providers are exempt.
Medium impact
Newsletter Vol. 24, No.05
New Jersey Medicaid·Effective Jun 1, 2014
New Jersey Medicaid providers must complete and submit a Medically Exempt Attestation Form for NJ FamilyCare Plan ABP patients who may qualify for medical exemptions due to serious mental health, substance abuse, complex medical conditions, or disabilities. This allows eligible patients to access full Medicaid State Plan benefits including long-term care services.
Medium impact
Newsletter Vol. 24, No.06
New Jersey Medicaid·Effective Jan 1, 2014
New Jersey Medicaid has relaxed utilization review error rate thresholds from 3% to 5% and simplified administrative day billing requirements for hospitals with patients awaiting non-nursing facility placement. Hospitals now only need to meet 2 out of 4 previous requirements for administrative day reimbursement when patients no longer need acute care but are awaiting discharge to group homes or other non-nursing facilities.
High impact
Newsletter Vol. 24, No.08
New Jersey Medicaid·Effective Jul 1, 2014
New Jersey Medicaid is implementing enhanced claims editing that requires all provider NPIs on claims to be registered with NJ Medicaid and properly linked to Medicaid Provider IDs. Claims will be denied if NPIs are not registered or if the NPI-Provider ID relationship is not documented.
High impact
Newsletter Vol. 24, No.09
New Jersey Medicaid·Effective Jul 1, 2014
New Jersey confirms FQHC wraparound reimbursement procedures requiring all Medicaid encounters to be processed through HMOs first before DMAHS payment, with a formal 15-day appeal process for denied claims. FQHCs must submit detailed claim-level data and cannot include pended, duplicate, or incorrectly denied claims in wraparound reports.
Low impact
Medicaid Alert - MA2014-01
New Jersey Medicaid·Effective Jul 1, 2014
New Jersey Medicaid launched Managed Long-Term Services and Supports (MLTSS) on July 1, 2014, requiring providers in four waiver programs (ACCAP, CRPD, TBI, and GO) to deliver services through NJ FamilyCare MCOs instead of directly. DHS offered provider education sessions in July 2014 to explain member eligibility verification, MCO networks, contracts, and resources.
High impact
Newsletter Vol. 24, No.07
New Jersey Medicaid·Effective Jul 1, 2014
New Jersey is transitioning certain Medicaid waiver services (ACCAP, CRPD, GO, TBI) to managed care organizations effective July 1, 2014. Providers must now bill MCOs directly for services provided on or after July 1, 2014, instead of the previous fee-for-service system.
High impact
Medicaid Alert - MA2014-02
New Jersey Medicaid·Effective Sep 1, 2014
New Jersey Medicaid now requires providers to report ICD version indicators on all paper UB-04 and 1500 claim forms. Claims must include '9' for ICD-9 codes or '0' for ICD-10 codes in designated fields, and claims will be denied if this information is missing or incorrect.
Medium impact
Newsletter Vol. 24, No. 11
New Jersey Medicaid·Identified Jun 20, 2026
New Jersey Medicaid has revised preventive care services guidelines and updated requirements for modifier '33' usage under the Affordable Care Act Section 4106. This affects billing for preventive care services that are mandated to be covered without cost-sharing.
High impact
Newsletter Vol. 24, No.12
New Jersey Medicaid·Effective Oct 1, 2015
New Jersey is requiring all NJFC/Charity Care providers to transition from ICD-9-CM/PCS diagnosis and procedure codes to ICD-10-CM/PCS codes effective October 1, 2015. Claims submitted with service dates on or after this date must use ICD-10 codes; claims with earlier service dates must continue using ICD-9 codes. The state is offering a testing environment through Molina Medicaid Solutions to allow providers to validate their ICD-10 coding before the mandatory compliance deadline.

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