All Insurance Policy Changes (Page 859)

Continuing from page 858. Showing older policy changes tracked across all payers. Use the filters in the related-hubs section below to narrow by provider, state, or specialty.

Low impact
Newsletter Vol. 35, No.12
New Jersey Medicaid·Effective Dec 5, 2025
NJ FamilyCare continues coverage for Hepatitis B vaccination for all members ages 0-18 years, aligning with American Academy of Pediatrics (AAP) guidelines and the December 5, 2025 NJ Department of Health Executive Directive No. 25-005. Coverage includes doses administered within 24 hours of birth and requires no additional medical necessity documentation. Billing follows current procedures through both fee-for-service and managed care delivery systems.
Medium impact
Newsletter Vol. 35, No.13
New Jersey Medicaid·Effective Dec 1, 2025
New Jersey's ADDP/HIPP program now covers medical copayments, deductibles, and out-of-pocket costs for HIV patients at 500% or below poverty line. Providers must bill patient's primary insurance first, then submit remaining patient costs to American Exchange for direct reimbursement instead of charging patients.
High impact
Newsletter Vol. 36, No.01
New Jersey Medicaid·Effective Jan 1, 2026
New Jersey now requires ABA, DIR, BA, and IIC providers to complete FBI background checks instead of state-only checks. Existing employees have until April 26, 2026 to complete the new federal background check requirement.
Low impact
Newsletter Vol. 36, No.02
New Jersey Medicaid·Effective Jan 1, 2026
New Jersey is launching the Behavioral Health Promoting Interoperability Program (BH PIP), a voluntary financial incentive program offering up to $55,000 in milestone-based payments to eligible behavioral health clinics that implement or upgrade EHR systems with interoperability capabilities. Eligible independent behavioral health facilities with ≥20% Medicaid patient volume must complete a questionnaire at NJII's website and submit documentation through NJMMIS for approval to receive incentive payments.
Medium impact
Newsletter Vol. 36, No.03
New Jersey Medicaid·Effective Apr 1, 2026
New Jersey Medicaid is launching a Community-Based Palliative Care (CBPC) benefit effective April 1, 2026. Eligible providers (hospice, home health, physician groups, independent clinics) can enroll starting February 2, 2026, with specific credentialing requirements and new HCPCS billing codes for assessments and monthly bundled payments.
Medium impact
Medicaid Alert MA-2026-01
New Jersey Medicaid·Effective Mar 1, 2026
Effective March 1, 2026, New Jersey Medicaid/NJFC now requires a prescription (individual or standing order) for all OTC COVID-19 at-home test kits, whereas they were previously covered without a prescription. Coverage remains at up to 8 tests per month; prior authorization is required for quantities exceeding 8 tests per rolling 30 days. Reimbursement methodology is based on actual acquisition cost using NADAC, WAC, FUL, SUL plus professional fee, or usual and customary charge, whichever is lowest.
High impact
Senior Services News Vol. 29, No. 01
New Jersey Medicaid·Effective Mar 15, 2026
New Jersey PAAD/Senior Gold pharmacy claims will be denied starting March 15, 2026 if Medicare Part D patient responsibility amounts exceed the $2,100 annual out-of-pocket maximum or LIS copayment limits ($5.10 generic, $12.65 brand). Pharmacies must ensure proper secondary billing to avoid new error codes 2358 and 2359.
Medium impact
Medicaid Alert MA-2026-02
New Jersey Medicaid·Effective Apr 1, 2026
New Jersey Medicaid is requiring all NJMMIS.com users to update and validate their contact information (email and/or phone number) to prepare for multi-factor authentication (MFA) deployment by late 2026. Users will be prompted at every login until they comply, and access will be blocked after MFA goes live for non-compliant users. Primary Account Administrators must also ensure all staff have individual sub-accounts rather than shared logins for HIPAA compliance.
Medium impact
Newsletter Vol. 36, No.04
New Jersey Medicaid·Effective Jul 1, 2025
New Jersey Medicaid now requires ABA providers (BCBAs, BCBA-Ds, and BCaBAs) to obtain state licensure from the Division of Consumer Affairs in addition to their existing certifications. Already enrolled providers can continue services but must submit their new license documentation to Gainwell Technologies.
Medium impact
Newsletter Vol. 36, No.05
New Jersey Medicaid·Effective Jul 1, 2025
New Jersey updated its tiered reimbursement rates for Assisted Living Residences (ALR) and Comprehensive Personal Care Homes (CPCH) effective July 1, 2025. Medicaid Partner Communities (facilities with 100% low-income residents under land use restriction agreements) now qualify for the highest tier rate for a minimum of two full rating periods instead of one, to allow time for enrollment ramp-up. Per diem rates range from $91.10–$126.10 for ALR and $81.10–$116.10 for CPCH based on Medicaid/NJ FamilyCare enrollment percentage.
High impact
Medicaid Alert MA-2026-03
New Jersey Medicaid·Effective Jun 1, 2026
Effective June 1, 2026, New Jersey Medicaid will implement new claims edits that pend or deny claims submitted for services rendered when a provider's required license is expired, inactive, suspended, or invalid. Billing teams must verify all providers' licensure information is current in the NJMMIS system and submit updated licenses to Gainwell Provider Enrollment if not listed, or claims will be denied after a 4-week pend period.
High impact
About ICD-10
Missouri Medicaid (MO HealthNet)·Effective Oct 1, 2014
ICD-10 coding system replaced ICD-9 on October 1, 2014. All healthcare providers must use ICD-10 codes for services on or after October 1, 2014, while continuing to use ICD-9 for services prior to that date.
Medium impact
Diabetes Self-Management Training
Missouri Medicaid (MO HealthNet)·Effective Jan 13, 2014
Diabetes self-management training services are not covered for adults receiving limited benefit packages under this Medicaid program. Providers must request exceptions through the Exceptions Process program before providing these services to participants with limited benefits.
High impact
ICD-10 - It's Not Just for MO HealthNet Providers
Missouri Medicaid (MO HealthNet)·Effective Oct 1, 2014
The healthcare industry will transition from ICD-9 to ICD-10 coding system on October 1, 2014. All healthcare providers covered by HIPAA must use ICD-10 codes for diagnosis coding on all medical and hospital claims starting this date, or risk nonpayment for services.
High impact
Planning for and Implementing ICD-10
Missouri Medicaid (MO HealthNet)·Identified Jun 20, 2026
This policy provides guidance for healthcare organizations to prepare for the transition to ICD-10 coding system. Organizations must develop comprehensive plans for project management, communication, assessment, implementation, testing, and post-transition operations to ensure a smooth transition.
High impact
ICD-10 Educational Series by Conference Call
Missouri Medicaid (MO HealthNet)·Effective Oct 1, 2014
Physician practices must transition to ICD-10 coding by October 1, 2014. Free educational conference calls are being offered by Missouri and Kansas medical associations in late February and March 2014 to help practices prepare for this mandatory coding change.
Medium impact
Reason Codes on Denial of Claims
Missouri Medicaid (MO HealthNet)·Effective Feb 10, 2014
MO HealthNet has provided access to standardized healthcare code lists including Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC) through Washington Publishing Company's website. These codes help explain claim adjustments and denials for better understanding of payment processing.
Medium impact
Using the Timely Filing Tab to Correct Claims
Missouri Medicaid (MO HealthNet)·Effective Feb 18, 2014
MO HealthNet has updated their timely filing correction process, allowing providers to use a dedicated Timely Filing Tab on their billing portal to correct and resubmit denied claims within specific timeframes. This streamlines the correction process for claims initially submitted within 12 months of service date but denied due to errors.
Low impact
MO HealthNet Medicaid Program Webinars
Missouri Medicaid (MO HealthNet)·Effective Feb 24, 2014
MO HealthNet (Missouri Medicaid) provides quarterly webinars for providers and requires participants to notify education staff verbally during webinars to ensure attendance credit is recorded. Providers should cancel registrations if unable to attend due to limited capacity of 12 participants per session.
Low impact
When to Contact Wipro Provider Communications
Missouri Medicaid (MO HealthNet)·Effective Mar 3, 2014
This policy provides contact information and procedures for providers to communicate with Wipro Provider Communications for MO HealthNet (Missouri Medicaid) regarding claim filing, resolution, and eligibility verification. Providers can contact via phone (573-751-2896, select 0 for specialist), secure email through the MO HealthNet portal, or written correspondence.
High impact
Provider Addresses Must Be Kept Current
Missouri Medicaid (MO HealthNet)·Effective Mar 10, 2014
Missouri Medicaid providers must keep their addresses current or face claim suspension. If mail is returned as undeliverable, providers' claims will be suspended for 180 days, then denied if no address update is submitted.
Medium impact
Do you want your claims to pay after Oct 1, 2014? Take the ICD-10 Clinical Survey Challenge Today!
Missouri Medicaid (MO HealthNet)·Effective Oct 1, 2014
MO HealthNet is inviting providers to complete an ICD-10 Clinical Survey to test readiness for the October 1, 2014 ICD-10 implementation. The survey is available on the emomed site and will help MO HealthNet assess provider preparedness and provide targeted training feedback.
Medium impact
Missouri Medicaid Audit and Compliance Notification to Providers
Missouri Medicaid (MO HealthNet)·Identified Jun 20, 2026
Missouri Medicaid is conducting targeted audits through Recovery Audit Contractors (RAC) and Medicaid Integrity Contractors (MIC). Hospice providers are currently being audited by MIC for eligibility documentation, while pharmacy and durable medical equipment providers will be audited by RAC for proper billing and duplicate payment prevention.
Medium impact
Double-Check Your Faxes
Missouri Medicaid (MO HealthNet)·Effective Mar 31, 2014
Healthcare providers must verify their fax machine's Calling-Station ID to prevent private health information breaches. When fax machines are leased or transferred, the programmed sender ID may belong to a previous user, causing automated responses to be sent to wrong recipients.
Medium impact
HIPPA - Related Code Lists
Missouri Medicaid (MO HealthNet)·Effective Apr 7, 2014
MO HealthNet has transitioned from using proprietary explanation codes to standardized HIPAA-compliant code sets on claim confirmation reports and remittance advices. Providers must now reference national standard codes (Claim Adjustment Reason Codes, Remittance Advice Remark Codes, and NCPDP reject codes) through Washington Publishing Company's HIPAA-Related Code Lists website.

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Archive by year

2023 2024 2025 2026

Newsletter Vol. 35, No.12

Newsletter Vol. 35, No.13

Newsletter Vol. 36, No.01

Newsletter Vol. 36, No.02

Newsletter Vol. 36, No.03

Medicaid Alert MA-2026-01

Senior Services News Vol. 29, No. 01

Medicaid Alert MA-2026-02

Newsletter Vol. 36, No.04

Newsletter Vol. 36, No.05

Medicaid Alert MA-2026-03

About ICD-10

Diabetes Self-Management Training

ICD-10 - It's Not Just for MO HealthNet Providers

Planning for and Implementing ICD-10

ICD-10 Educational Series by Conference Call

Reason Codes on Denial of Claims

Using the Timely Filing Tab to Correct Claims

MO HealthNet Medicaid Program Webinars

When to Contact Wipro Provider Communications

Provider Addresses Must Be Kept Current

Do you want your claims to pay after Oct 1, 2014? Take the ICD-10 Clinical Survey Challenge Today!

Missouri Medicaid Audit and Compliance Notification to Providers

Double-Check Your Faxes

HIPPA - Related Code Lists