Newsletter Vol. 27, No.01

By April 1, 2017: Billing team must implement new prior authorization workflow for NJ FamilyCare mental health partial care services. (1) Update billing system to distinguish between new admission requests (6-week authorization) and continuation requests (90-day authorization). (2) Obtain FD-07 Prior Authorization Request Form and ensure all new admission requests are submitted on this form. (3) Require providers to submit signed Individual Recovery Plan (IRP) with all continuation requests; IRP must include signatures from licensed clinician, beneficiary, and Medical Director, all dated within 7 days before service start date. (4) Implement system to track IRP signature dates and modify authorization start dates if signatures are dated after IRP start date indicated on form. (5) Train front-desk and billing staff that prior authorization requests will be DENIED if IRP lacks required signatures or lacks documentation of why client did not sign. (6) Implement tracking for 90-day review schedule: four consecutive 90-day IRPs must be completed in first year, then switch to 6-month reviews thereafter, with review cycle beginning on date of first IRP service, not admission date. (7) Prevent billing for any service dates prior to IRP signature date. Failure to comply will result in claim denials and service authorization denials.