Newsletter Vol. 1, No. 03

IMMEDIATELY: Billing team must implement the following changes: (1) Obtain and begin using the new FD Form (Medical Supplies and DME Prior Authorization) for all prior authorization requests to the Medicaid District Office (MDO); providers may use the NJ claim form as interim prior auth form until FD supplies arrive. (2) Update billing procedures to require mandatory prior authorization for ANY medical supplies, DME rentals, or DME purchases when charges are $500 or more. (3) Ensure all claims are submitted to Unisys (CN-Trenton, New Jersey) using the NJ claim form with accurate, detailed completion per the Fiscal Agent Billing Supplement. (4) For HCPCS code E (unclassified supplies/equipment): enter E only once on FD or NJ form with a narrative list of all items and prices; attach itemized list and price lists with claim; enter composite charge amount on NJ claim detail line when billing. (5) Keep signed FD or NJ authorization documents in recipient files for post-payment audit verification. (6) Enter 'Prior Authorization File' in Field 12 (REMARKS) on NJ claim form; do NOT enter prior authorization number in Field 8 (this instruction is deferred). (7) For Medicare/Medicaid dual-eligible recipients: use FD or NJ form, bill Medicare as primary, enter 'Medicare/Medicaid Client' in REMARKS field, and attach Medicare EOB with hardcopy claims submitted to Medicaid as secondary. (8) Verify Type of Service is coded as 'OTHER' in Field C on claim forms. (9) Use appropriate modifiers: N (new equipment), UE (used equipment), R (repair/replace), RR (rental). CONSEQUENCES: Claims not properly completed will be returned, suspended, or denied.