MedicaidCoverageHigh impact
Newsletter Vol. 27, No.14
New Jersey Medicaid·NJ · Psychiatry, Emergency Medicine, Critical Care +1 more·Medical Policy
Effective date
Jan 1, 2018
We identified it
Jun 20, 2026
Summary
Effective January 1, 2018, New Jersey FamilyCare (NJFC) managed care organizations must now cover all mental health and substance use disorder services for MLTSS, FIDE SNP, and DDD beneficiaries. Additionally, all general acute care hospital admissions (including psychiatric units) and all emergency ambulance transports become MCO responsibilities for all NJFC managed care enrollees. Bill these services to the MCO instead of the state FFS program.
Action Required
By December 31, 2017: Billing team must update claim submission protocols to route behavioral health services (mental health, SUD services), general acute care hospital admissions, and emergency ambulance transports to the MCO instead of the state FFS program for NJFC beneficiaries. Update claim adjudication rules to identify MLTSS, FIDE SNP, and DDD members and automatically direct claims to their MCO. For air ambulance transports (HCPCS A0431, A0436) and associated mileage, bill the MCO for all NJFC managed care enrollees. Verify member enrollment status with MCO before claim submission. Train billing staff that certain services (TCM through JIS/CSOC/ICMS/PATH, PACT, BHH, CSS, and stand-alone psychiatric hospital admissions for non-MLTSS/FIDE SNP/DDD members) remain FFS-covered and should continue to be billed to the state. Failure to bill to the correct payer will result in claim denials and revenue loss.