Summary
New Jersey Medicaid/NJ FamilyCare now offers enhanced reimbursement rates for Advanced Practice Nurses (APNs) in family medicine and pediatrics specialties when working in qualified physician group practices. All physicians in the group must complete and submit an ACA Self-Attestation Form by June 1, 2013 to receive enhanced rates for E&M services and vaccine administration. Claims will be denied with Error Code 1343 if the group practice has not complied with self-attestation requirements.
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What to do
Action · 10 steps
01CRITICAL DEADLINE - By June 1, 2013: All physicians in the qualified physician group practice must complete and submit the ACA Self-Attestation Form to Molina Medicaid Solutions (mailed to P.O.
02Box 4804, Trenton, NJ 08650-4804).
03The form cannot be faxed and must include an original New Jersey Uniform Prescription Blank for identification.
04Each physician must attest to either current Board certification (as of January 1, 2013) OR demonstrate that 60% of their 2012 Medicaid/NJFC claims volume was for E&M procedures (CPT 99201-99499) and vaccine administration (including CPT 90460 and 90461 billed to managed care).
05Billing Team: Ensure APN's NPI is reported as the servicing provider on all claims to qualify for enhanced rates.
06Practice Managers: Verify all physicians in the group have submitted signed Self-Attestation Forms before submitting APN claims.
07Billing System: Update system to track group practice self-attestation compliance status.
08Claims submitted by non-compliant groups will be denied with Error Code 1343 'Group Practice not in compliance Self-Attestation Required.' Only APNs certified in family medicine or pediatrics working under physician supervision in qualified physician groups (family medicine, internal medicine, or pediatrics) are eligible.
09Enhanced rates are limited to service dates January 1, 2013 through December 31, 2014.
10Retroactive payments will be issued once the State increases primary care rates and obtains federal approval.
Codes mentioned
99201992029920399204992059921199212992139921499215992179921899219992209922199222992239922499225992269922799231992329923399234992359923699238992399924199242992439924499245992519925299253992549925599281992829928399284992859929199292994999046090461
Original notice
Newsletter Vol. 23, No.08
njmmis.com · Always check the source before changing claims.
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Related policy hubs
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