Traditional MedicareAdministrativeHigh impact
Newsletter Vol. 30, No.02
New Jersey Medicaid·NJ · Psychiatry·Medical Policy
Effective date
Jan 1, 2020
We identified it
Jun 20, 2026
Summary
Starting January 1, 2020, Medicare became the primary payer for all dually eligible beneficiaries receiving opioid treatment through OTPs. OTP providers must enroll in Medicare to maintain Medicaid eligibility and bill Medicare first for dual-eligible patients.
Action Required
Immediately: OTP providers must apply for Medicare enrollment to obtain PTAN and provider agreement. Billing team must verify eligibility for all beneficiaries on specific dates of service and bill Medicare as primary payer for dually eligible beneficiaries. Update billing workflows to handle Medicaid recoupment back to Medicare enrollment effective date. Prepare for future edit requiring Medicare primary billing once all OTPs are Medicare-enrolled.