Newsletter Vol. 30, No.24

By December 31, 2020: (1) Billing team must update billing system to require First Visit PRA Plus form submission to FHI before prenatal claim reimbursement is processed for NJFC Medicaid beneficiaries. (2) Providers and clinical staff must be trained to complete and electronically submit the First Visit PRA Plus form during the first prenatal visit; access training manual at www.Praspect.org. (3) Update encounter forms and EMR templates to trigger PRA Plus form completion as a required step for all prenatal visits. (4) Establish verification process to confirm PRA form receipt from FHI before releasing claims for payment. (5) Implement system alert for Error Code 1459 denials; if PRA form is not received within 30 days of service, claim will be automatically denied—staff must resubmit form and rebill. (6) Verify that patient demographics (BIN, name, date of birth) reported on PRA form exactly match REVS/MEVS/eMEVS eligibility data; mismatches will cause form rejection. (7) If provider changes during pregnancy, new provider must also complete and submit First Visit PRA Plus form. (8) For hospital outpatient clinics billing prenatal services, report Revenue Code 51X and comply with PRA requirements. Failure to submit PRA Plus form will result in claim denial and loss of reimbursement.