MedicaidPrior AuthHigh impact
Newsletter Vol. 7, No. 66
New Jersey Medicaid·NJ · Dentistry·Prior Authorization
Effective date
Nov 19, 1997
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid is reinstating prior authorization requirements for dental procedure code 09920 (Behavior Management), effective November 19, 1997. All claims for this code must now be pre-authorized by the Bureau of Dental Services, and the beneficiary's disability must be documented in Section 20 of the authorization request form (MC-10A). Claims submitted without prior authorization will be denied.
Action Required
By November 19, 1997: Dental providers must obtain prior authorization for ALL behavior management procedures (code 09920) before rendering services. Action items: (1) Billing team must update internal systems to flag code 09920 as requiring prior authorization; (2) Providers must complete form MC-10A, Request for Prior Authorization (Rev 9-91), and submit to Division of Medical Assistance and Health Services, Dental Claims Review Unit, Unit Mail Code No. 21, P.O. Box 713, Trenton, N.J. 08625-0713; (3) In Section 20 of the form, MUST specify the beneficiary's disability that necessitates behavior management; (4) Front desk staff should update encounter forms and provider instructions to include prior authorization requirement reminders. CONSEQUENCE: Any claims for code 09920 submitted without prior authorization, or with authorization requests lacking disability specification in Section 20, will be denied and not reimbursed.