Newsletter Vol. 19, No. 45

By January 1, 2010: Billing team and clinical staff must implement the following: (1) Stop billing partial care services for NJ FamilyCare/Medicaid clients 18+ without prior authorization after the 30-day new admission grace period; (2) For new admissions: Complete comprehensive assessment within 30 calendar days, then submit completed FD-07 and FD-07A forms to the appropriate Medical Assistance Customer Center (MACC) by county; (3) For established clients: Stagger prior authorization requests over the six-month implementation period (July 1, 2009 – January 1, 2010), submitting 1/6 of your Medicaid census monthly with staggered start dates; (4) Ensure all prior authorization forms include: current DSM diagnosis with code, current medication list and response, clinical history (length of illness, hospitalizations, safety issues, comorbidities), recovery/treatment plan with community integration goals, and present clinical status documenting current utilization, hospitalization risk, screening center contacts, substance abuse/medical comorbidities, safety issues, and functional deficits; (5) Request service units based on current utilization (e.g., 5 hours/day × 2 days/week = 260 units); (6) Communicate acute mid-authorization changes to assigned Medicaid reviewer for reevaluation; (7) Send all completed requests via mail or fax to the appropriate county MACC office. Consequence: Claims will be denied without prior authorization after the 30-day grace period.