All Insurance Policy Changes (Page 851)

Continuing from page 850. 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. 28, No.14
New Jersey Medicaid·Identified Jun 20, 2026
New Jersey is replacing its 25-year-old Medicaid Management Information System (NJMMIS) with Health PAS (RMMIS), effective implementation date to be determined. All NJ FamilyCare Fee-for-Service providers must complete new HIPAA Trading Partner Agreement (TPA) registration online and submit three test files per transaction type to remain eligible for payments. Provider Medicaid ID numbers will change from 7-digit legacy IDs to National Provider Identifiers (NPIs), and taxonomy codes will determine billable service scope.
Low impact
Newsletter Vol. 28, No.15
New Jersey Medicaid·Effective Jul 1, 2018
New Jersey is lifting its 12-year moratorium on medical supplier enrollment in the NJ FamilyCare Fee-for-Service program, allowing new medical supply providers to enroll and existing limited providers to become fully enrolled. Medical suppliers can now receive full NJFC FFS reimbursement when NJFC is the primary payer.
High impact
Newsletter Vol. 28, No.16
New Jersey Medicaid·Effective Jul 1, 2018
New Jersey Medicaid (NJ FamilyCare) changed how Maximum Patient Pay Liability (PPL) is calculated for nursing facilities and assisted living facilities effective July 2018. Different rates now apply based on living arrangement (nursing facility, assisted living, or MLTSS at home) and dual/non-dual eligibility status. A system discrepancy between NJMMIS calculations and County Welfare Agency Personal Responsibility forms caused underpayments in July-August 2018 for 350 affected individuals; the state directed CWAs to update forms by August 15, 2018, and recycle claims for retroactive adjustments.
Medium impact
Newsletter Vol. 28, No.17
New Jersey Medicaid·Identified Jun 20, 2026
New Jersey Family Care (NJFC) now covers telemedicine and telehealth services with the same reimbursement as face-to-face visits. Providers must use interactive, real-time audio-video technology with minimum 384 kbps bandwidth and follow specific documentation and patient authentication requirements.
Medium impact
Newsletter Vol. 28, No.18
New Jersey Medicaid·Effective Jul 1, 2018
NJ FamilyCare (NJFC/Medicaid) now covers Long-Acting Reversible Contraceptive (LARC) device insertion in the inpatient hospital setting immediately postpartum (within 10 minutes after delivery). Physicians must bill for both the LARC product and insertion procedure using specific CPT and HCPCS codes. LARC product reimbursement is capped at Wholesale Acquisition Cost (WAC) minus 1% or physician's charge, whichever is less.
Low impact
Senior Services News Vol. 21, No. 01
New Jersey Medicaid·Effective Jan 1, 2019
New Jersey updated 2019 income eligibility limits for pharmaceutical assistance programs (PAAD, Senior Gold, Lifeline, HAAAD) based on 2.8% Social Security COLA increase. PAAD eligibility is now less than $27,951 for singles and $34,268 for couples, while Senior Gold covers incomes between those amounts and $37,951/$44,268 respectively.
Low impact
Medicaid Alert MA2018-04
New Jersey Medicaid·Identified Jun 20, 2026
New Jersey Medicaid confirms that billing procedures for Substance Abuse Initiative (SAI) providers have NOT changed for Short-Term Residential, Long-Term Residential, and Residential Withdrawal Management services. Providers should continue using existing SAI procedure codes despite a July 2018 newsletter announcing new coverage.
Low impact
Medicaid Alert MA2018-05
New Jersey Medicaid·Identified Jun 20, 2026
DXC Technology has acquired Molina Medicaid Solutions, which may affect Medicaid billing processes, provider portals, or administrative procedures. This is an operational change that billing teams should monitor for potential system or process updates.
Low impact
Newsletter Vol. 28, No.19
New Jersey Medicaid·Identified Jun 20, 2026
The New Jersey Drug Utilization Review Board (DURB) is issuing clinical guidance recommending metformin as the first-line pharmacologic treatment for type 2 diabetes, citing superior safety profile, cost-effectiveness (average savings of $181 per claim vs. other diabetic drugs), and robust clinical evidence. This is an advisory bulletin to encourage broader prescribing of metformin before alternative antidiabetic agents, with updated safety guidance on use in chronic kidney disease based on eGFR thresholds rather than serum creatinine.
High impact
Newsletter Vol. 28, No.20
New Jersey Medicaid·Effective Nov 1, 2018
New Jersey hospitals must reduce reimbursement for non-emergent emergency room visits to a flat $140.00 triage fee effective November 1, 2018. Claims are evaluated based on the first three diagnosis codes and procedure codes (99281-99285); if all meet low-acuity criteria, the $140 fee applies instead of full reimbursement. Specific exceptions exist for pregnant women, children ≤6 years, seniors ≥65 years, and cases with emergency certification.
Medium impact
Newsletter Vol. 28, No.21
New Jersey Medicaid·Effective Nov 1, 2018
New Jersey's NJ FamilyCare now permits billing for clinical social work services provided by supervised social work interns in independent mental health and substance use disorder clinics. Previously, clarity was lacking on reimbursability. Services are now billable if they meet all standard billing requirements except for the licensed clinician requirement, provided all documentation is co-signed by a supervising licensed professional.
Medium impact
Newsletter Vol. 28, No.22
New Jersey Medicaid·Effective Nov 1, 2018
Effective November 1, 2018, New Jersey changed the authorization process for Personal Care Assistance (PCA) services under Fee-For-Service NJ FamilyCare (Medicaid). Instead of the Division of Disability Services handling authorizations, providers must now submit PCA assessments to specific Medical Assistance Customer Centers (MACC) based on their county location.
High impact
Newsletter Vol. 28, No.23
New Jersey Medicaid·Effective Oct 1, 2018
New Jersey Medicaid (NJ FamilyCare) is transitioning from AP-DRG Version 27 to APR-DRG Version 34 for inpatient hospital reimbursement effective October 1, 2018. All claims must now include a four-digit APR-DRG code (three-digit base DRG plus one-digit severity indicator). Claims submitted without all four digits will be denied.
Medium impact
Newsletter Vol. 29, No.01
New Jersey Medicaid·Effective Jan 1, 2019
New Jersey Medicaid clarified billing procedures for urine drug testing in substance use disorder programs, introducing a new code H0048 HF ($2.50) for collection-only services when samples are sent to external labs, while maintaining H0003 HF for on-site testing.
Medium impact
Newsletter Vol. 29, No.02
New Jersey Medicaid·Effective Jan 1, 2019
New Jersey FamilyCare (Medicaid) now covers substance use disorder services for youth under 18 years of age, effective immediately. Previously, coverage was limited to beneficiaries 18 years and older.
Medium impact
Newsletter Vol. 29, No.03
New Jersey Medicaid·Identified Jun 20, 2026
This policy update addresses billing procedures for partial care services, which are intensive outpatient mental health programs. The newsletter provides coding guidance and billing requirements for these specialized psychiatric services.
Medium impact
Newsletter Vol. 29, No.04
New Jersey Medicaid·Effective Feb 1, 2019
New Jersey increased the Personal Needs Allowance (PNA) for SSI recipients in nursing facilities from a lower amount to $50 per month, effective February 1, 2019. Retroactive payments covering the period from July 1, 2017 through January 2019 were also disbursed in February 2019. Billing teams must ensure SSI recipient accounts reflect the new $50/month PNA standard going forward.
High impact
Newsletter Vol. 29, No.05
New Jersey Medicaid·Effective Mar 1, 2019
New Jersey Medicaid has transferred Medical Day Care (MDC) prior authorization responsibility from Division of Aging Services to Division of Medical Assistance and Health Services. All MDC prior authorization requests must now be mailed to Monmouth Medical Assistance Customer Center with specific documentation requirements and new service codes for pediatric patients.
High impact
Newsletter Vol. 29, No.06
New Jersey Medicaid·Effective Jan 1, 2019
New Jersey eliminates prior authorization requirements for all Medication Assisted Treatment (MAT) medications and services effective January 1, 2019, and establishes the Office Based Addictions Treatment (OBAT) program to expand MAT access through primary care providers. The policy introduces new reimbursement codes for Navigator services and increases intake/evaluation assessment rates effective April 1, 2019.
Medium impact
Medicaid Alert MA2019-01
New Jersey Medicaid·Effective Apr 1, 2019
New Jersey Medicaid has implemented enhanced security procedures for NJMMIS login credential exchanges effective immediately. Key changes include: passwords and usernames will no longer be sent together in a single letter, credentials are valid for only 30 days before requiring reapplication, registration and credential letters will be sent separately via certified mail, and terminated providers cannot request new credentials. These changes apply to all providers and submitters accessing the New Jersey Medicaid Management Information System.
High impact
Medicaid Alert MA2019-02
New Jersey Medicaid·Effective May 1, 2019
Effective May 1, 2019, New Jersey Medicaid requires that pharmacy claims report only Type 1 NPIs (individual practitioner identifiers) for prescribers, not Type 2 NPIs (group/facility identifiers). Pharmacy claims submitted with Type 2 NPIs will be denied with Error Code 2298. Billing teams must verify prescriber NPIs are Type 1 entities before claim submission.
High impact
Newsletter Vol. 29, No.07
New Jersey Medicaid·Effective Apr 1, 2019
New Jersey clarifies billing rules for Community Support Services (CSS) under NJ FamilyCare Medicaid, effective April 1, 2019. Providers can now bill for services provided on behalf of consumers, services case management, staff contributions to Individualized Rehabilitation Plans (IRP), and assessments (PRNA/CRNA) performed by licensed practitioners. Prior authorization through IME-CSS utilization management is required. Direct transportation (one exception) is not reimbursable.
High impact
Newsletter Vol. 29, No.09
New Jersey Medicaid·Effective Apr 1, 2019
New Jersey clarifies billing requirements for Intensive Outpatient (IOP) substance use disorder services. IOP services must be billed in complete 3-hour units using code H0015HF and can only be billed when the full 3 hours are completed on the same date of service. IOP services cannot be combined with individual outpatient services in the same week, and a minimum of 3 days per week is required for qualification as IOP.
High impact
Medicaid Alert MA2019-03
New Jersey Medicaid·Effective May 1, 2019
New Jersey Medicaid requires pharmacies to report Patient Residence identifiers in NCPDP field 384-4X on all pharmacy claims effective immediately. Claims missing or containing invalid residence codes will be denied with Error Code 2230. Pharmacies must select from 11 accepted identifier values (01=Home, 02=SNF, 03=Nursing Facility, 04=Assisted Living, 05=Custodial Care, 06=Group Home, 09=ICF/ID, 11=Hospice, 15=Correctional Institution, or 00=Not Specified).
Medium impact
Newsletter Vol. 29, No.10
New Jersey Medicaid·Identified Jun 20, 2026
New Jersey FamilyCare (Medicaid) provides coverage for SBIRT (Screening, Brief Intervention and Referral to Treatment) services for substance use disorders. Four billing codes are available with different reimbursement rates for specialists vs non-specialists/clinics, with services billable by physicians, PAs, APNs, clinical psychologists, and clinical social workers.

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Newsletter Vol. 28, No.14

Newsletter Vol. 28, No.15

Newsletter Vol. 28, No.16

Newsletter Vol. 28, No.17

Newsletter Vol. 28, No.18

Senior Services News Vol. 21, No. 01

Medicaid Alert MA2018-04

Medicaid Alert MA2018-05

Newsletter Vol. 28, No.19

Newsletter Vol. 28, No.20

Newsletter Vol. 28, No.21

Newsletter Vol. 28, No.22

Newsletter Vol. 28, No.23

Newsletter Vol. 29, No.01

Newsletter Vol. 29, No.02

Newsletter Vol. 29, No.03

Newsletter Vol. 29, No.04

Newsletter Vol. 29, No.05

Newsletter Vol. 29, No.06

Medicaid Alert MA2019-01

Medicaid Alert MA2019-02

Newsletter Vol. 29, No.07

Newsletter Vol. 29, No.09

Medicaid Alert MA2019-03

Newsletter Vol. 29, No.10