MedicaidPrior AuthHigh impact
Newsletter Vol. 12, No. 68
New Jersey Medicaid·NJ · Psychiatry·Provider Notice
Effective date
Sep 5, 2002
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid/NJ FamilyCare – Plan A now covers Programs of Assertive Community Treatment (PACT) services for eligible beneficiaries age 18+ with chronic severe mental illness. Providers must submit claims using HCPCS code Z3370, obtain prior authorization via form FD-07, and file retroactive claims (Sept 5, 2001 – Sept 30, 2001) by August 20, 2002 to meet timely filing deadlines.
Action Required
URGENT - By August 20, 2002: Billing team must immediately submit all retroactive PACT claims with dates of service between September 5, 2001 and September 30, 2001 to Unisys (Medicaid/NJ FamilyCare fiscal agent) to meet timely filing deadline. Going forward: (1) PACT providers must enroll as Medicaid/NJ FamilyCare PACT providers in the system; (2) For all new PACT claims effective September 1, 2002+, obtain prior authorization using DMAHS form FD-07 submitted to the Statewide PACT Coordinator at the address listed before providing services; (3) Configure billing system to require prior authorization number on all PACT claims; (4) Update claim submission process to use HCPCS code Z3370 for monthly comprehensive PACT services ($1235.00 for 09/05/01-06/30/02; $1260.00 for 07/01/02+); (5) Implement logic to prevent simultaneous billing of PACT services and mental health Personal Care Assistant (PCA) services in the same month; (6) If prior authorization number not received by August 20, 2002, file claim without PA number to preserve timely filing. Failure to obtain prior authorization will result in claim denials. Claims without proper prior authorization cannot be processed by Unisys.