Newsletter Vol. 26, No. 06

REQUIREMENTS: - By July 1, 2016: Billing team must update all billing software and systems to remove the requirement for the '22' modifier on all SUD treatment service codes. The modifier is no longer necessary as both NJFC Plan A and ABP beneficiaries now access the same services. - Immediately: Providers must begin routing all SUD treatment authorization requests through the Interim Management Entity (IME) at 1-844-276-2777 for NJFC Plan A and ABP consumers. Update internal procedures and staff training to reflect IME as the prior authorization entity. - Before July 1, 2016: Billing team must verify NJFC Plan A and ABP member eligibility using MEVS or REVS before service delivery. Flag any members with limited benefit packages (e.g., incarcerated individuals receiving only inpatient acute care). Update eligibility verification protocols in billing system. - By July 1, 2016: Billing team must update fee schedules to reflect new weekly bundled MAT rates for methadone, buprenorphine/buprenorphine-naloxone, and other MAT medications. Bundled rate includes: medication dispensing, drug costs, individual/group counseling, case management, and medication monitoring. - By July 1, 2016: Update billing system to ensure CPT 90791 and 90792 (comprehensive assessments by psychiatrist) do not require prior authorization. All other physician services must use CPT 99201-99215 codes. - By July 1, 2016: Billing team must remove the '22' modifier from all existing SUD treatment service line items in billing templates and encounter forms. - By July 11, 2016: Implement prior authorization requirements for applicable SUD services per DMHAS guidelines using NJSAMS and ASAM criteria. Failure to obtain required prior authorization will result in claim denials by the State of New Jersey. - Ongoing: Verify NJFC eligibility prior to each service; consult MEVS/REVS to identify limited benefit packages. Providers with no claim activity for 18 months will be automatically disenrolled and must re-apply using form FD-20. - Specialty: SUD treatment providers and facilities billing NJFC Plan A or ABP beneficiaries.