Newsletter Vol. 32, No.05

By April 1, 2022: (1) Billing team must update claims submission process to include Family Planning Indicator field (Field SV112 for professional claims or A4 field for outpatient hospital claims) populated with 'Y' for all services with Coverage Indicator values of 'C', 'D', or for breast tomosynthesis, mammograms, and HPV vaccinations. (2) For services with Coverage Indicator 'F' or 'S', Family Planning Indicator population is not required but may be included. (3) Update billing software to require ICD-10-CM diagnosis codes O09.0-O16, O20-O21, O23-O26, O28-O31, O36, O44-O48, or Z33-Z34 on all NJSPCP claims. (4) Configure system to submit claims directly to Gainwell Technologies (1-800-776-6334) for NJSPCP beneficiaries identified with Program Status Code (PSC) 391. (5) Providers must verify beneficiary eligibility using REVS (1-800-676-6562) or MEVS before submitting claims. (6) Train front desk staff to ensure applicants receive printed NJSPCP program information and that applications include indication of NJ FamilyCare eligibility when applicable. Failure to properly populate Family Planning Indicator field will result in Error Code 1011 denials; claims without required diagnosis codes will be denied.