CBHS/PFC/CSOCI Newsletter Vol. 03, No. 06

REQUIREMENTS: - By January 2, 2004: Register all staff for mandatory training on January 6, 2004 with ValueOptions (Maria Sherry, 609-689-6231) regarding admission procedures, Joint Care Review process, and authorization requirements. - Effective January 1, 2004: Billing team must update workflows to require prior authorization for ALL admissions and continued stays in residential mental health facilities (RTCs, group homes, treatment homes, psychiatric community residences) for Medicaid/NJ FamilyCare/PFC members. - On date of admission: Providers must call CSA by telephone to obtain authorization number for reimbursement. ONLY authorization numbers from CSA authorize payment. - For emergency admissions Monday-Friday (8:00 a.m.–10:00 p.m.): DYFS or CMO must contact CSA for confirmation number with "EMER" prefix; provider calls CSA same day for authorization number. - For emergency admissions (10 p.m.–8 a.m., weekends, or holidays): DYFS or CMO contacts CSA prior to 10 a.m. next business day; provider calls CSA next business day for verbal authorization number. - By February 1, 2004: All claims must have proper authorization or will be denied. During January 1–31 transition period, PFC will work closely with providers to ensure no service disruption. - Maintain CSA contact information: Phone (609-689-6231), Fax (609-689-6260) for non-admission notifications. - For out-of-state facilities not coordinated by CCIS/DYFS/CMO: Continue contacting DMAHS Office of Utilization Management at 609-588-2749. - Consequences: Claims for services provided without proper authorization will be DENIED effective February 1, 2004.