All Insurance Policy Changes (Page 849)

Continuing from page 848. 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
Medicaid Alert - MA2016-03
New Jersey Medicaid·Effective Nov 1, 2016
New Jersey Medicaid is enforcing stricter National Provider Identifier (NPI) reporting requirements for Division of Developmental Disabilities (DDD) and Community Care Waiver (CCW) claims, effective immediately. Billing teams must ensure each service location has a unique servicing provider NPI separate from the billing provider NPI, or claims will be denied with specific error codes. Both the 7-digit Medicaid billing provider ID and 10-digit NPI must be reported correctly on all claim submissions.
Low impact
Newsletter Vol. 26, No.16
New Jersey Medicaid·Identified Jun 20, 2026
The New Jersey Drug Utilization Review Board issued a provider notice regarding HIV Pre-Exposure Prophylaxis (PrEP) using Truvada (tenofovir/emtricitabine). This is an informational bulletin encouraging appropriate prescribing of PrEP for high-risk individuals, addressing documented under-utilization. The notice provides clinical guidance on patient eligibility, dosing, follow-up requirements, and monitoring protocols for providers in New Jersey.
Medium impact
Newsletter Vol. 26, No.17
New Jersey Medicaid·Effective Dec 1, 2016
New Jersey Medicaid now allows assisted living facilities (ALR and CPCH) to bill Fee-for-Service rates for eligible residents who are pending managed care enrollment, effective December 1, 2016. Providers must notify the Division and receive approval before billing the established per diem rates using codes T2031 and T2031_U1.
Medium impact
Newsletter Vol. 26, No.18
New Jersey Medicaid·Effective Oct 1, 2015
New Jersey Medicaid has updated the ICD-10 procedure codes that require second surgical opinions for elective procedures including hysterectomy, spinal fusion, laminectomy, and hernia repair. This replaces previous ICD-9 code lists for claims with service dates on or after October 1, 2015.
High impact
Medicaid Alert - MA2016-04
New Jersey Medicaid·Effective Feb 1, 2017
New Jersey Medicaid has established strict rules for reporting dates of service on behavioral health claims effective February 1, 2017. Most behavioral health services must be billed with single dates only - span date reporting is prohibited for therapy, assessments, and most services, requiring separate claims for each date when services span multiple days.
High impact
Medicaid Alert - MA2016-05
New Jersey Medicaid·Effective Feb 15, 2017
New Jersey Medicaid is updating its claims processing system to support 2017 ICD-10-CM and ICD-10-PCS codes. Claims with service dates on or after October 1, 2016 using new 2017 codes may be denied with Error Codes 0248 or 0296 during system maintenance; these claims must be resubmitted. After February 15, 2017, the system will be fully updated and claims with Error Codes 1449 or 1450 will automatically recycle without requiring resubmission.
High impact
Newsletter Vol. 27, No.01
New Jersey Medicaid·Effective Apr 1, 2017
New Jersey FamilyCare program establishes revised prior authorization requirements for mental health partial care services effective April 1, 2017. All initial requests for new admissions must use FD-07 form with 6-week authorization for comprehensive assessment, followed by submission of signed Individual Recovery Plan (IRP) for 90-day authorization. Existing authorizations require resubmission with updated IRP at end of authorized period. IRPs must be signed by licensed clinician, beneficiary, and Medical Director within 7 days before service start date.
Medium impact
Newsletter Vol. 27, No.02
New Jersey Medicaid·Effective Jan 1, 2017
New Jersey Medicaid is implementing a 0.3% Social Security Cost of Living Adjustment (COLA) effective January 1, 2017, which will increase resident cost-share amounts by an estimated $2-$7 per month at nursing homes and assisted living facilities. Nursing home and assisted living providers must notify residents or their representatives of this increase and choose between two collection options: billing the COLA amount immediately or notifying residents to save excess income pending their case redetermination.
Low impact
Newsletter Vol. 27, No.03
New Jersey Medicaid·Effective Apr 1, 2017
New Jersey is implementing new pharmacy reimbursement rules under the Covered Outpatient Drug Rule, changing from Estimated Acquisition Cost to Actual Acquisition Cost pricing and replacing dispensing fees with professional fees. This affects NJ FamilyCare (April 1, 2017) and PAAD/Senior Gold programs (July 1, 2017).
High impact
Newsletter Vol. 27, No.04
New Jersey Medicaid·Effective Apr 1, 2017
New Jersey is establishing state coverage and reimbursement procedures for 340B Drug Discount Program prescriptions under NJ FamilyCare and ADDP pharmacy programs. Pharmacies operated by covered entities (DSH hospitals, FQHCs, independent clinics) must now report 340B drugs using NCPDP code '08' in Field 423-DN and will be subject to claim-level edits to prevent duplicate manufacturer rebates. Contract pharmacies are explicitly ineligible for 340B reimbursement.
Medium impact
Medicaid Alert MA2017-01
New Jersey Medicaid·Effective Oct 1, 2015
New Jersey Medicaid has identified incorrect DRG grouping and payment issues for inpatient hospital claims since ICD-10 implementation on October 1, 2015, due to faulty 3M mapping software. The state will automatically recycle and reprocess affected claims through August 2017 to correct payment errors.
Low impact
Newsletter Vol. 27, No.05
New Jersey Medicaid·Identified Jun 20, 2026
New Jersey has issued clinical guidance on naloxone (Narcan) prescribing for opioid overdose prevention. This is an educational bulletin encouraging providers to co-prescribe naloxone to high-risk patients and provides clinical criteria for identifying candidates.
Medium impact
Newsletter Vol. 27, No.06
New Jersey Medicaid·Effective Jul 1, 2017
NJ FamilyCare (New Jersey Medicaid) clarifies that over-the-counter smoking cessation products (nicotine gum, lozenges, patches) ARE covered by their program. For dual-eligible beneficiaries, billing teams must submit OTC smoking cessation claims to Medicaid first, not Medicare Part D, and must use proper NDC codes instead of UPC codes.
High impact
Newsletter Vol. 27, No.07
New Jersey Medicaid·Effective Nov 1, 2016
New Jersey Medicaid (NJFC/FFS) now covers Community Support Services (CSS) as a carved-out mental health benefit for eligible consumers with serious mental illness who are discharged from psychiatric hospitals or in supportive housing. Providers must enroll in the NJFC FFS program, submit CSS-specific forms (Enrollment/Admission, IRP, CRNA) to an Interim Management Entity for utilization management review, and use Special Program Codes (SPCs 19-26, 39) to identify CSS initiatives in the eligibility system. Claims with service dates on or after November 1, 2016 are eligible for FFS payment if the consumer meets strict eligibility criteria and an Individualized Rehabilitation Plan (IRP) is submitted within 60 days of admission.
Medium impact
Newsletter Vol. 27, No.08
New Jersey Medicaid·Identified Jun 20, 2026
This appears to be a newsletter notice regarding Independent Clinic Services, but without access to the actual policy content, the specific changes affecting billing operations cannot be determined from the summary information provided.
High impact
Medicaid Alert MA2017-02
New Jersey Medicaid·Effective Oct 1, 2018
New Jersey Medicaid is transitioning from a 7-digit Provider ID system to NPI-only identification in the new R-MMIS claims processing system launching in late 2018. Providers with multiple Provider IDs linked to the same NPI, or those without NPI information on file, must respond to an NPI Data Confirmation Request Form from Molina Medicaid Solutions to avoid claim payment interruptions. After R-MMIS implementation, NPI will be the sole provider identifier for New Jersey Medicaid.
Medium impact
Newsletter Vol. 27, No.09
New Jersey Medicaid·Effective Aug 1, 2017
New Jersey Medicaid has clarified that Pre-eligibility Medical Expenses (PEME) are available for both nursing facilities and assisted living facilities, allowing facilities to request payment for bills incurred up to 3 months prior to Medicaid eligibility through the recipient's monthly cost share. A specific PEME request form must be submitted to the County Welfare Agency.
Medium impact
Newsletter Vol. 27, No.10
New Jersey Medicaid·Effective Jul 1, 2017
New Jersey increased the Personal Needs Allowance for Medicaid nursing facility residents from $35 to $50 per month, reducing their cost share payments by $15. Nursing facilities will receive an additional $15 per month from MCOs or the state to compensate for this reduction in resident payments.
Low impact
Newsletter Vol. 27, No.11
New Jersey Medicaid·Identified Jun 20, 2026
This newsletter provides new information and reminders specifically for dental services billing and procedures. Without access to the full policy content, the specific changes affecting dental billing practices cannot be determined from the summary alone.
Medium impact
Newsletter Vol. 27, No.12
New Jersey Medicaid·Effective Sep 1, 2017
New Jersey is implementing a standardized cost-share collection process for PACE (Program for All-Inclusive Care for the Elderly) members who reside in nursing facilities or assisted living facilities, effective September 1, 2017. Facilities must now collect monthly cost-share payments from PACE members based on Personal Responsibility (PR) forms issued by County Welfare Agencies, and PACE organizations must submit collective cost-share amounts to the state with a required DMAHS PACE Beneficiary Template.
Medium impact
Medicaid Alert MA2017-03
New Jersey Medicaid·Effective Aug 15, 2017
New Jersey Medicaid is now reporting cost share amounts (patient responsibility for Long Term Services and Supports) directly in eMEVS system responses, effective August 15, 2017. Billing teams must verify that MCO claim deductions match the eMEVS-reported cost share amounts and follow a new dispute resolution process for discrepancies.
Medium impact
Senior Services News Vol. 20, No. 01
New Jersey Medicaid·Effective Jan 1, 2018
New Jersey's PAAD (Pharmaceutical Assistance to the Aged and Disabled) and Senior Gold programs have updated income eligibility limits effective January 1, 2018, based on a 2% Social Security COLA adjustment. PAAD limits are now less than $27,189 for single persons and less than $33,334 for married couples. Senior Gold limits are $27,189-$37,189 for singles and $33,334-$43,334 for married persons. Billing teams must verify patient eligibility against these new thresholds when processing pharmacy benefits.
High impact
Newsletter Vol. 27, No.13
New Jersey Medicaid·Effective Jun 5, 2017
New Jersey FamilyCare (NJFC) now covers Ambulatory Withdrawal Management (AWM) services using HCPCS code H0014-HF at $220.00 per day for fee-for-service members, effective June 5, 2017. Prior authorization is required through the Interim Management Entity (IME), with initial authorizations limited to 5 days. Starting January 1, 2018, managed care plan members (MLTSS, DDD, FIDE SNP) transition to their plan for AWM coverage and prior authorization.
High impact
Newsletter Vol. 27, No.14
New Jersey Medicaid·Effective Jan 1, 2018
Effective January 1, 2018, New Jersey FamilyCare (NJFC) managed care organizations must now cover all mental health and substance use disorder services for MLTSS, FIDE SNP, and DDD beneficiaries. Additionally, all general acute care hospital admissions (including psychiatric units) and all emergency ambulance transports become MCO responsibilities for all NJFC managed care enrollees. Bill these services to the MCO instead of the state FFS program.
High impact
Newsletter Vol. 27, No.15
New Jersey Medicaid·Effective Jul 1, 2018
Effective July 1, 2018, NJ FamilyCare is expanding managed care organization (MCO) coverage for behavioral health and substance use disorder services for MLTSS, FIDE SNP, and DDD beneficiaries. Additionally, all general acute care hospital admissions (including psychiatric units) become MCO responsibility for all NJFC managed care enrollees. Emergency air transport responsibility transfers to MCOs effective January 1, 2018. Certain services (TCM, PACT, BHH, CSS) remain FFS-covered.

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Medicaid Alert - MA2016-03

Newsletter Vol. 26, No.16

Newsletter Vol. 26, No.17

Newsletter Vol. 26, No.18

Medicaid Alert - MA2016-04

Medicaid Alert - MA2016-05

Newsletter Vol. 27, No.01

Newsletter Vol. 27, No.02

Newsletter Vol. 27, No.03

Newsletter Vol. 27, No.04

Medicaid Alert MA2017-01

Newsletter Vol. 27, No.05

Newsletter Vol. 27, No.06

Newsletter Vol. 27, No.07

Newsletter Vol. 27, No.08

Medicaid Alert MA2017-02

Newsletter Vol. 27, No.09

Newsletter Vol. 27, No.10

Newsletter Vol. 27, No.11

Newsletter Vol. 27, No.12

Medicaid Alert MA2017-03

Senior Services News Vol. 20, No. 01

Newsletter Vol. 27, No.13

Newsletter Vol. 27, No.14

Newsletter Vol. 27, No.15