Newsletter Vol. 29, No.08

By October 1, 2019: Billing team must (1) Update billing system to recognize Plan First Program Status Codes (PSC) 381 and 764; (2) Configure system to require and enforce Family Planning Indicator field (SV112) population with 'Y' value for CPT codes with Coverage Indicator values C, D, or breast tomosynthesis/mammograms/HPV services, or claims will deny with Error Code 1011; (3) For services with Coverage Indicator F or S, system should not require SV112 population; (4) Update claim scrubbing logic to enforce third-party billing requirement before Medicaid submission; (5) Create provider alert system to capture when Plan First patients report pregnancy, with mandatory notification process to dmahs.familyplanning@dhs.state.nj.us including patient name, case number, expected due date, and number of expected babies; (6) Providers must verify Plan First eligibility includes income 139-205% FPL, non-pregnant status, no prior sterilization, NJ residency, and US citizenship/qualified immigrant status before authorizing services; (7) Train billing staff that Plan First covers only family planning and family planning-related services—abortion, hysterectomy, inpatient hospital services, and immunizations other than HPV are NOT covered; (8) Update billing procedures to recognize that sterilization services require supportive documentation; (9) Implement denial management process for Error Code 1011 and establish workflow to request state correction for retroactive prenatal visit coverage.