MedicaidAdministrativeHigh impact
Newsletter Vol. 31, No.22
New Jersey Medicaid·NJ · Pediatrics, Psychiatry·Coding
Effective date
Oct 1, 2021
We identified it
Jun 20, 2026
Summary
New Jersey's Department of Medical Assistance & Health Services requires Electronic Visit Verification (EVV) for all claims submitted for Agency Hired Respite (AHR), Intensive-In-Home Behavioral (IIH-B), and Individual Support Services (ISS) through DCF/CSOC effective October 1, 2021. Providers must complete EVV training and submit 100% of claims supported by verified visit data or risk member transition to compliant agencies.
Action Required
By October 1, 2021: Provider agencies billing for AHR, IIH-B, or ISS services must complete EVV system onboarding and training through HHAeXchange (visit https://hhaexchange.com/nj-dmahs/). Billing team must ensure: (1) Provider survey is completed, (2) HHAeXchange LMS modules or training webinars are attended, (3) All claims for procedure codes H2015HM, H2015HAHO, H2016HAHO, H2015HAHN, H2016HAHN, T2021HAHN, T2021HAHO, H0031HA, H0031HA22, H0031HAHP, 96158HA, 96159HA, and S9125HA52 are submitted with verified EVV visit data capturing all six required data elements (service type, individual receiving service, date, location, provider, begin/end time). Update billing system to enforce EVV verification before claim submission. Failure to comply will result in claim denials and potential member transition to EVV-compliant providers. Contact DCF.EVVCSOC@dcf.nj.gov or mahs.evv@dhs.state.nj.us for questions.