MedicaidCoverageMedium impact
Newsletter Vol. 12, No. 12
New Jersey Medicaid·NJ · OB-GYN, Family Medicine, General Practice·Provider Notice
Effective date
Jul 1, 2001
We identified it
Jun 20, 2026
Summary
New Jersey established the Supplementary Prenatal Care Program (NJSPCP) effective July 1, 2001, providing limited prenatal care coverage for pregnant women ineligible for standard Medicaid/NJ FamilyCare due to immigration status. Billing teams must verify eligibility through REVS (1-800-676-6562) or MEVS, restrict billing to prenatal-related primary care, pharmaceuticals, radiology, and lab services only, and use ICD-9-CM codes 640-648.9 or V22-V23.89. Labor and delivery services are excluded from this program.
Action Required
By February 10, 2002: (1) Billing team must update eligibility verification procedures to check NJSPCP status via REVS at 1-800-676-6562 or MEVS vendor before processing claims. (2) Configure billing system to accept ONLY ICD-9-CM primary diagnoses 640-648.9 and V22-V23.89 for NJSPCP beneficiaries. (3) Restrict claimable services to prenatal-related primary care, pharmaceutical, radiology, and clinical laboratory services provided by clinics/hospitals only. (4) Implement hard stop in billing software to reject claims for labor/delivery services under NJSPCP (route these to Medical Emergency Payment Program for Aliens instead). (5) Update encounter forms and provider education materials to clearly state coverage limitations. (6) Train front-desk and billing staff to educate eligible women that monthly PE ID cards state 'Services limited to prenatal, provided by clinics and hospitals only.' Failure to verify eligibility and restrict services will result in claim denials and overpayments.