Newsletter Vol. 23, No.08

CRITICAL 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. Box 4804, Trenton, NJ 08650-4804). The form cannot be faxed and must include an original New Jersey Uniform Prescription Blank for identification. Each 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). IMMEDIATE ACTIONS: (1) Billing Team: Ensure APN's NPI is reported as the servicing provider on all claims to qualify for enhanced rates. (2) Practice Managers: Verify all physicians in the group have submitted signed Self-Attestation Forms before submitting APN claims. (3) Billing System: Update system to track group practice self-attestation compliance status. Claims 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. Enhanced rates are limited to service dates January 1, 2013 through December 31, 2014. Retroactive payments will be issued once the State increases primary care rates and obtains federal approval.