All Insurance Policy Changes (Page 856)

Continuing from page 855. 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. 32, No.24
New Jersey Medicaid·Effective Sep 1, 2022
New Jersey Medicaid/NJ FamilyCare has updated requirements for Behavioral Assistance (BA) and Intensive In-Community (IIC) service providers, mandating that all existing providers who have not completed background checks and all new providers must initiate criminal background checks through the Department of Children and Families (CSOC) and Employment Controls and Compliance Unit (ECCU) before enrollment or service provision. Providers can no longer use private companies for background checks; all staff providing face-to-face services and agency heads must be cleared through the state-approved vendor. New hires and staff changes require driver's license verification and educational documentation submission to CSOC for CYBER system access and claim reimbursement eligibility.
Medium impact
Newsletter Vol. 32, No.25
New Jersey Medicaid·Identified Jun 20, 2026
This is a clinical newsletter from the New Jersey Drug Utilization Review Board (DURB) regarding drug utilization management. Without access to the full content, the specific policy changes cannot be determined from the summary alone.
Medium impact
Medicaid Alert MA-2022-02
New Jersey Medicaid·Effective Oct 1, 2022
New Jersey Medicaid has established a specific billing procedure for Cabenuva® (cabotegravir/rilpivirine) administration through the AIDS Drug Distribution Program (ADDP). Providers must bill CPT 96372 with modifier AG for a reimbursement rate of $7.43 per monthly dose, and must ensure the beneficiary's primary health plan is billed first before ADDP processes as payer of last resort.
Medium impact
Medicaid Alert MA-2022-03
New Jersey Medicaid·Effective Jan 1, 2022
New Jersey Medicaid is replacing two sets of teen-directed family planning HCPCS codes with consolidated codes effective January 1, 2022 and January 1, 2023. Code 99201 FP22 is replaced by 99203 FP22 for initial/annual visits (effective 1/1/2022), and codes 99393 FP52, 99394 FP52, and 99395 FP52 are replaced by 99213 FP22 for follow-up visits (effective 1/1/2023). The new codes combine E/M evaluation and management services with teen-directed family planning requirements.
Low impact
Senior Services News Vol. 25, No. 01
New Jersey Medicaid·Effective Jan 1, 2023
New Jersey updated 2023 income eligibility limits for pharmaceutical assistance programs (PAAD and Senior Gold) based on 8.7% Social Security COLA increase. PAAD income limits are now less than $42,142 for singles and $49,209 for couples, while Senior Gold limits are $42,142-$52,142 for singles and $49,209-$59,209 for couples.
Medium impact
Newsletter Vol. 32, No.26
New Jersey Medicaid·Effective Dec 5, 2022
New Jersey Medicaid is replacing its ClaimCheck® claims auditing system with ClaimsXten® software effective December 5, 2022. The new system will continue applying the same NCCI edits but introduces three new edit codes that may result in different claim denial reasons.
High impact
Medicaid Alert MA-2022-04
New Jersey Medicaid·Effective Jan 15, 2023
New Jersey Medicaid is replacing Level III HCPCS codes with Level II HCPCS codes for Children's System of Care (CSOC) providers to comply with national standards. Twenty-four Y-codes and one Z-code are being replaced with H-codes and T-codes, with two codes being terminated entirely.
Low impact
Newsletter Vol. 32, No.27
New Jersey Medicaid·Effective Jan 1, 2023
New Jersey Medicaid/NJ FamilyCare now covers up to a 12-month supply of FDA-approved contraceptive products when prescribed by a provider. Pharmacies can dispense extended supplies with proper prescription authorization starting January 1, 2023.
High impact
Medicaid Alert MA-2022-06
New Jersey Medicaid·Effective Jan 1, 2023
New Jersey Medicaid is expanding reporting requirements for patient discharge status codes effective January 1, 2023. Hospitals must now report specific NUBC discharge status codes (01-95) in UB-04 Form Locator 17, including new codes for substance abuse rehabilitation (70) and Hospital at Home programs (81). This ensures compliance with national billing standards and accurate claim reporting.
Medium impact
Medicaid Alert MA-2022-05
New Jersey Medicaid·Effective Dec 1, 2022
New Jersey Medicaid/NJ FamilyCare expanded coverage for at-home SARS-CoV-2 test kits effective immediately. Nine additional OTC test kit brands (identified by NDC codes) are now covered, joining four previously announced kits. Pharmacy providers must update their systems to recognize and process claims for these newly covered NDCs.
Medium impact
Newsletter Vol. 33, No.01
New Jersey Medicaid·Effective Jan 1, 2023
New Jersey DHS has launched Naloxone365, a program allowing pharmacies to dispense free naloxone anonymously to any NJ resident age 14+ regardless of Medicaid eligibility. Pharmacies billing NJFC/Medicaid FFS must use standardized placeholder patient information (Jane Doe, DOB 010199) and a specific recipient ID (580200000020) to request reimbursement. This applies to FDA-approved 4mg naloxone nasal spray products only, with one 2-spray package per dispense and no weekly limit.
High impact
Newsletter Vol. 33, No.03
New Jersey Medicaid·Effective Jan 1, 2023
This is a compliance reminder (not a new change) regarding Section 6032 of the Federal Deficit Reduction Act of 2005. Entities receiving ≥$5,000,000 in annual Medicaid/NJ FamilyCare Title XIX payments must maintain written compliance policies covering federal and state false claims laws, whistleblower protections, fraud prevention procedures, and perform monthly exclusion/licensure checks on employees and contractors. Annual attestation and documentation requirements apply.
Medium impact
Newsletter Vol. 33, No.06
New Jersey Medicaid·Effective Mar 1, 2023
New Jersey requires all BA/IIC service providers to complete state-administered fingerprint background checks instead of private company checks, effective immediately. Current staff with private checks are grandfathered until February 28, 2025, and all staff requiring patient transportation must provide driver's license attestations.
Medium impact
Newsletter Vol. 32, No.28
New Jersey Medicaid·Identified Jun 20, 2026
Electronic Visit Verification (EVV) is now required for all Medicaid Fee for Service and Managed Care Organization providers billing for home health care services under the 21st Century Cures Act mandate. This affects claims payment processing for home health services.
High impact
Newsletter Vol. 33, No.07
New Jersey Medicaid·Effective Apr 1, 2023
Effective April 1, 2023, New Jersey expanded DIR (Developmental, Individual Difference, Relationship-Based) service eligibility and provider qualifications for children under 21 with Autism Spectrum Disorder diagnoses (F84.0-F84.9). Non-master's level providers with DIR certification and high school diploma can now provide services under master's-level supervision. Billing now includes new supervision codes (96156EP26) and updated health behavior intervention codes (96158EP-96171EP) with specific daily unit limits and face-to-face supervision requirements.
High impact
Newsletter Vol. 33, No.08
New Jersey Medicaid·Effective Apr 1, 2023
New Jersey Medicaid/NJ Family Care is mandating a transition to Medicare-aligned HCPCS billing codes for all Opioid Treatment Program (OTP) services effective April 1, 2023. Providers must replace current OTP billing codes with new HCPCS codes (G2067-G2079), including new codes for long-acting injectable medications (buprenorphine and naltrexone). Claims submitted with old codes on or after April 1, 2023 will be denied.
High impact
Newsletter Vol. 33, No.05
New Jersey Medicaid·Effective Mar 20, 2023
New Jersey Medicaid is implementing a permanent automated system (NJMMIS) to process and reimburse Medicare cost-share claims for Qualified Medicare Beneficiary (QMB) individuals effective March 20, 2023. Claims will electronically crossover from Medicare, eliminating the previous manual process. Providers must be enrolled in Medicaid/NJ FamilyCare FFS program to receive QMB cost-share payments and are prohibited from billing QMB individuals for Medicare deductibles, coinsurance, or copayments.
Medium impact
Medicaid Alert MA-2023-01
New Jersey Medicaid·Effective May 12, 2023
New Jersey Medicaid/NJ FamilyCare now covers at-home SARS-CoV-2 test kits for members denied coverage by primary benefit plans (including Part D) from May 12, 2023 through September 30, 2024, without cost-sharing. Claims must be submitted as POS claims and are limited to 8 OTC tests per month without prescription, with additional quantities requiring prescriber authorization.
Medium impact
Newsletter Vol. 33, No.09
New Jersey Medicaid·Effective May 11, 2023
New Jersey Medicaid/NJ FamilyCare is terminating coverage for four specific COVID-19 specimen collection and diagnostic testing procedure codes effective May 11, 2023. These codes can no longer be billed to Medicaid following the end of the Public Health Emergency.
High impact
Newsletter Vol. 33, No.02
New Jersey Medicaid·Effective Apr 1, 2023
New Jersey requires all healthcare providers and MCOs to conduct monthly background checks on all employees and contractors (current and prospective) who furnish, order, direct, manage, or prescribe services to ensure they are not excluded, unlicensed, or uncertified individuals. Providers must search five mandatory databases and report any excluded individuals to the State Comptroller. Non-compliance may result in claim denials, recovery demands, and civil penalties.
High impact
Medicaid Alert MA-2023-02
New Jersey Medicaid·Effective May 11, 2023
New Jersey Medicaid is requiring providers to use updated Facility Code values for telehealth claims effective May 11, 2023. Use Facility Code '10' when telehealth is provided in a patient's home, and use the updated Facility Code '02' for telehealth provided at other locations. This applies to both Fee-For-Service and encounter claims.
Medium impact
Medicaid Alert MA-2023-03
New Jersey Medicaid·Identified Jun 20, 2026
New Medicaid billing and coding requirements have been established for claims related to Non-Medically Indicated Early Elective Delivery procedures. This policy provides specific guidance on how to properly code and submit claims for these delivery scenarios.
High impact
Medicaid Alert MA-2023-04
New Jersey Medicaid·Effective May 12, 2023
Effective May 12, 2023, New Jersey Medicaid is discontinuing pharmacy billing accommodations that were implemented during the federal Public Health Emergency. Practices must reinstate pre-PHE billing procedures, including reactivating prescription signature requirements and reverting 90-day supply dispensing and early refill allowances to standard limits.
High impact
Newsletter Vol. 33, No.10
New Jersey Medicaid·Effective May 11, 2023
New Jersey Medicaid is terminating COVID-19 Public Health Emergency flexibilities effective May 11, 2023. Prior authorization requirements are being reinstated, alternative care settings will no longer be reimbursed, HCBS service plans require beneficiary/provider signatures again, PASRR assessments resume, presumptive eligibility restrictions apply, pharmacy 90-day supplies and early refills end, and family members can no longer provide personal care services. Billing teams must update workflows to require prior authorizations, verify PASRR compliance before admissions, reinstate signature requirements, and transition beneficiaries receiving family-based personal care services to compliant providers.
High impact
Newsletter Vol. 33, No.11
New Jersey Medicaid·Effective Oct 1, 2023
New Jersey Medicaid/NJ FamilyCare updated billing rounding policies effective October 1, 2023 for Home Health, Personal Care Assistance (PCA), and Private Duty Nursing (PDN) services. Providers must now meet specific minimum time thresholds to bill units: for 15-minute units, a minimum of 8 minutes is required for the initial unit; for hourly units, a minimum of 53 minutes is required. DDD Community Support services have separate rounding rules allowing aggregation of non-continuous sessions with specific half-unit rounding guidelines. E/M and psychiatric codes retain existing time requirements without change.

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. 32, No.24

Newsletter Vol. 32, No.25

Medicaid Alert MA-2022-02

Medicaid Alert MA-2022-03

Senior Services News Vol. 25, No. 01

Newsletter Vol. 32, No.26

Medicaid Alert MA-2022-04

Newsletter Vol. 32, No.27

Medicaid Alert MA-2022-06

Medicaid Alert MA-2022-05

Newsletter Vol. 33, No.01

Newsletter Vol. 33, No.03

Newsletter Vol. 33, No.06

Newsletter Vol. 32, No.28

Newsletter Vol. 33, No.07

Newsletter Vol. 33, No.08

Newsletter Vol. 33, No.05

Medicaid Alert MA-2023-01

Newsletter Vol. 33, No.09

Newsletter Vol. 33, No.02

Medicaid Alert MA-2023-02

Medicaid Alert MA-2023-03

Medicaid Alert MA-2023-04

Newsletter Vol. 33, No.10

Newsletter Vol. 33, No.11