MedicaidCoverageHigh impact
Newsletter Vol. 32, No.12
New Jersey Medicaid·NJ · Pediatrics·Provider Notice
Effective date
May 1, 2022
We identified it
Jun 20, 2026
Summary
Effective May 1, 2022, NJ FamilyCare Pediatric Medical Day Care facilities are reopening for in-person services. Providers may now bill for on-site services with a U1 modifier or continue billing remote services, but cannot bill for both on the same day. Remote service claims now require documented proof of parent/caregiver contact, meal/supply delivery, and face-to-face visits where requested, with post-payment review for program integrity.
Action Required
By May 1, 2022: Billing team must implement the following changes: (1) Update billing system to append U1 modifier to all on-site Pediatric Medical Day Care claims billed to MCOs; (2) Configure system to prevent billing for both on-site and remote services on the same day for the same member; (3) Establish documentation requirement for remote service claims to include evidence of telephonic contact with parent/caregiver, meal/supply delivery, and face-to-face visits as requested; (4) Implement claim review process for remote services before submission to MCOs; (5) Providers must notify MCOs and parents/caregivers of on-site service resumption dates; (6) If facility closure occurs, providers must immediately notify MCO care management. Failure to append U1 modifier will prevent DMAHS tracking of reopening progress. Remote service claims lacking required documentation will be subject to post-payment review and potential denial.