Summary
New Jersey Medicaid adds 14 new dental procedure codes effective January 1, 2007, with updated billing requirements for prior authorizations, claim corrections, and oral evaluations. Billing teams must implement these codes in their system, ensure prior authorization numbers are legibly recorded, use modifiers correctly (especially EP for pediatric evaluations), and submit claim adjustments using the FD-999 form to UNISYS.
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What to do
Action · 10 steps
01REQUIREMENTS:
- By October 1, 2008: Update billing software to enforce NPI pre-printing and consecutive serialization on all prescription blanks (Rx Blank requirement effective 10/1/2008).
02- Immediately: Add all 14 new CDT-2007/2008 procedure codes (D0145, D0150EP, D0273, D1206, D1555, D2970, D5225, D5226, D6091, D6092, D7292, D7293, D7951, D8693, D9612) to billing system with correct prior authorization requirements indicated by the cross (+) symbol where applicable.
03- Before next claim submission: Billing team must update system configuration to REQUIRE the 10-digit prior authorization number (beginning with 11) to be legibly written on all dental claim forms in section 17-B; claims submitted without this number will experience payment delays.
04- Immediately: Update billing system to flag any modified procedure codes (when section 17-C differs from 17-B) and ensure the modified code from 17-C is reported in section 17-B on the dental claim form.
05- Immediately: Ensure all fee amounts in section 17-I are formatted with dollars, cents, and decimal point (e.g., 300.00, not 300).
06- Immediately: Implement validation to prevent any writing in shaded areas of dental forms to avoid processing delays.
07- For all pediatric oral evaluations (patients through age 20): Billing team must verify that modifier EP is appended to code D0150EP; claims without this modifier will be denied.
08- Immediately: Update claim correction workflow to use NJMMIS Claims Adjustment Request Form (FD-999), available at www.njmmis.com Billing Supplement pages 145-149, and submit to UNISYS CN 4802, Trenton, NJ 08650 with supporting dental claim form and Remittance Advice.
09- Before next denial follow-up: Establish escalation protocol—contact UNISYS Provider Services at 1-800-776-6334 for status on submissions under 4 weeks; escalate to Bureau of Dental Services at 1-609-588-7136 only for denials or submissions exceeding 4 weeks without processing.
10- Failure to implement these changes will result in claim denials, payment delays, and processing rejections.
Codes mentioned
D0145D0150EPD0273D1206D1555D2970D5225D5226D6091D6092D7292D7293D7951D8693D9612
Original notice
Newsletter Vol. 18, No. 08
njmmis.com · Always check the source before changing claims.
Related changes
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