Medicaid Alert - MA-2009-03

On or after July 1, 2009: Billing and clinical teams must implement prior authorization workflow for all partial care mental health services. (1) Obtain FD-07 and FD-07A forms from NJMMIS.com (Forms and Documents > Provider > All > Medicaid Forms order); (2) Ensure providers complete forms in their entirety with documentation demonstrating client meets admission criteria per 10:37F-2.1 and requires continued partial care services; (3) Submit completed prior authorization forms before service delivery; (4) Update billing system to flag all partial care claims as requiring prior auth verification before submission to Medicaid; (5) Train front desk and authorization staff on new requirement. Failure to obtain prior authorization will result in claim denials from NJ Medicaid for all partial care services provided to FamilyCare/Medicaid clients by independent clinics.