Notices

Aetna Better Health of New Jersey publishes provider notices containing up-to-the-minute information you may need to know from our regulators, new coding/claims processing rules, or any other new plan information. Our goal is to keep you as well informed about our plan as possible. Be sure to check this page often.

What's new

Provider notices

Subject: Notice to Home Health, Personal Care Assisant and Nursing Facility Providers

Date: October 19, 2020


The New Jersey Fiscal Year 2021 budget has increased several rates that that Aetna Better Health of New Jersey and other Medicaid Managed Care Organizations must pay for the following services:

Service

State mandated reimbursement rate

Effective date

Medical Day Care (Adult Day Health Services)      

$82.00 per day

10/1/2020

Nursing Facilities Rates

Specific rate set by NJ Medicaid for each facility

10/1/2020

Personal Care Assistant (PCA) Services

$21 per hour

7/1/2020 to 8/31/2020

$19 per hour

9/1/2020 to 9/30/2020

$20 per hour

10/1/2020 to 6/30/2021

Private Duty Nursing Services  - RN

$60 per hour

10/1/2020

Private Duty Nursing Services  - LPN

$48 per hour 

10/1/2020

Aetna Better Health of New Jersey will update our payment system to include the new rate effective October 1, 2020. To account for the new rate, Aetna Better Health of New Jersey will retroactively adjust any impacted claim payments for dates of service on or after October 1, 2020. You will not need to resubmit claims, as Aetna Better Health of New Jersey will reprocess based on claims already submitted.

If you have any questions regarding Aetna Better Health of New Jersey implementation of this rate change, please contact Mary Pagano, Network Relations Manager at PaganoM@aetna.com.

Subject: Eviti Connect

Date: September 24, 2020


Eviti Provider Notice Letter   |   Eviti Training Information

We are pleased to announce that Aetna Better Health of New Jersey and NantHealth have partnered to give you access to Eviti Connect, an online software system that enables real-time decision support and treatment guidelines for oncology patients.

Effective November 1, 2020 there will be a change of process for initiating oncology treatment plan review requests. View Provider Notice Letter above for more information.

Subject: Prenatal Risk Assessment (PRA)

Date: September 18, 2020


Aetna Better Health of New Jersey would like to inform you about State law P.L.2019, c.88 that mandates the completion of the PRA form for pregnant women receiving state-supported Medicaid health coverage.

The law began in the state Legislature as Senate Bill 3406 as a package of bills designed to improve the health of expectant mothers and newborns. The goal is to decrease increasing rates of maternal and infant mortality in New Jersey. The PRA form is now required documentation for all uninsured, Medicaid presumptively eligible, and Medicaid eligible prenatal patient. This law impacts obstetrical providers, nurse midwives, and other licensed healthcare professionals.

What do OB Providers need to do?

OB Providers will need to submit the required PRA form to be reimbursed for OB services.  If the forms are not received, payment may be impacted.

Please follow the steps and register below to submit the PRA Forms:

Complete and submit the initial visit, follow-up visit and third trimester visit PRA forms.  The initial visit PRA form should be completed during the first prenatal visit, the follow-up PRA form when there is a change in insurance or maternal risk factor identified and the third trimester form at 30-36 weeks gestation.  All prenatal care providers must register with Family Health Initiatives (FHI) in order to access the PRA/SPECT. 

Register online at http://praspect.org or call 1-856-665-6000.  New users must register by calling FHI at 1-856-665-6000 or emailing PRA@FHIworks.org.  PRA forms are submitted by logging into http://praspect.org.

Subject: Notice to Personal Care Assistance Providers

Date: September 10, 2020


Section 12006 of the Twenty First Century Cures Act (Cures Act) and The Centers for Medicare & Medicaid Services (CMS) has mandated that Electronic Visit Verification (EVV) will be required for all Personal Care Services by January 1, 2021 and all Home Health Care Services by January 1, 2023.

In order to assess how each provider will be EVV compliant across the Medicaid program (FFS and Managed Care), we have developed a survey in connection with all other New Jersey Managed Care Organizations (MCOs) and New Jersey DMAHS to indicate your choice for EVV data collection. Click here to access the survey.

Click here for more information.

Subject: 21st Century Cures Act Re-issue

Date: August 19, 2020


21st Century Cures Act Re-issue

REMINDER: The Division of Medical Assistance and Health Services (DMAHS) has asked that we share the above newsletter to ensure ABHNJ providers are aware that they must enroll in the NJFC Medicaid FFS program. ABHNJ  providers currently enrolled in the NJFC Medicaid FFS program or who have already obtained NJ Medicaid Provider ID number need not take any action in response to this Newsletter.

Compliance is mandatory. Failure to comply may result in a provider’s contract with ABHNJ being terminated.

If you have questions about this mandate or an application, please contact DXC Technology Provider Enrollment Unit at 609-588-6036.

Subject: Notice to Personal Care Assistance Providers

Date: August 6, 2020


The New Jersey Department of Human Services, Division of Medical Assistance and Health Services (DMAHS) has increased the minimum hourly rate requirements that Aetna Better Health of New Jersey and other Medicaid Managed Care Organizations must pay for Personal Care Assistance (PCA) services.

 

Effective July 1, 2020, the new, mandated rate for PCA services to individuals is $21 per hour for services provided from July 2020 to August 2020 and $19 per hour for services provided from September 2020 to June 2021.

 

As always, providers must bill Aetna Better Health of New Jersey for such PCA services in 15-minute units using code T1019.

 

Aetna Better Health of New Jersey will update our payment system to include the new rate effective July 1, 2020. To account for the new rate, Aetna Better Health of New Jersey will retroactively adjust any impacted claim payments for dates of service on or after July 1, 2020. You will not need to resubmit claims, as Aetna Better Health of New Jersey will reprocess based on claims already submitted.

 

If you have any questions regarding Aetna Better Health of New Jersey implementation of this rate change, please contact Mary Pagano, Network Relations Manager at PaganoM@aetna.com.

Subject: [REMINDER] Providers must enroll with the State Medicaid Program or risk being removed from the provider network

Date: June 19, 2020


THE NEW JERSEY MEDICAID PROGRAM HAS ASKED THAT WE SEND THIS REMINDER TO YOU FOR IMMEDIATE ACTION

 

Effective January 1, 2018, the 21st Century Cures Act 114 P.L. 255, all Medicaid managed care network providers must enroll with the state Medicaid program or risk being removed from the provider network. Please note that this is a federal and state requirement and we were asked to send this notice to remind you of what you need to do immediately. Enrollment as a NJ FamilyCare provider does not require you to service NJ FamilyCare Fee-forService beneficiaries. To safeguard your status in the provider network you must enroll in the state Medicaid program. The 21st Century Cures Act Enrollment Application should be submitted to Molina Medicaid Solutions by December 31, 2017. Providers should continue to provide services to NJ FamilyCare members as the enrollment application is processed by Molina. The link for the 21st Century Cures Act application for enrollment can be accessed at: www.njmmis.com. The application can be downloaded and forwarded to the NJ Medicaid Provider Enrollment office for processing. Should you have questions during the NJ FamilyCare Program enrollment process please contact the NJMMIS provider enrollment unit at 609-588-6036. The mailing address to submit the application and credentials is:

Molina Medicaid Solutions

Provider Enrollment

P.O. Box 4804

Trenton, NJ 08650

 

The completed application with credentials can also be faxed to: 609-584-1192. If you receive this letter from multiple managed care plans, you only need to submit a single NJ Medicaid enrollment application. You may be asked to provide evidence of your submission, so you are encouraged to keep a copy of your application. If you have any additional questions regarding how or why you were identified as a provider who needs to enroll in the NJ FamilyCare Program, please contact the NJMMIS provider enrollment unit at 609-588-6036. Thank you for your prompt attention and cooperation.

Subject: NJ Human Services Commissioner Urges Medicaid & CHIP Providers to Act on Federal Funding Available to Help with COVID-19 Costs

Date: June 10, 2020


Press Release on Federal Funding

Subject: COVID-19 Communications Update: Resumption of Prior Authorization/ Precertification and Admissions Protocols 

Date: June 1, 2020


Prior Authorization Notification Update

Subject: Aetna Better Health of NJ has updated its New Jersey Medicaid Regulatory Compliance Addendum in accordance with the State of New Jersey.

Date: April 1, 2020


New Jersey Medicaid Regulatory Compliance Addendum

Subject: New Policy Updates - Clinical Payment, Coding and Policy Changes

Date: July 1, 2019


We regularly augment our clinical, payment and coding policy positions as part of our ongoing policy review processes. In an effort to keep our providers informed, please see the below chart of upcoming new policies.

Effective for dates of service beginning Q4 2018  

DIAGNOSIS CODE GUIDELINES-ICD10 EXCLUDES 1 NOTES-One of the unique attributes of the ICD-10-CM code set is the new concept of Excludes 1 Notes. An Excludes 1 Note indicates that the excluded code identified in the note should never be used at the same time as the code or code ranges above the Excludes 1 Note in the ICD10 manual. An Excludes 1 Note is used to indicate when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition. These conditions are mutually exclusive code combinations.

Examples:

 

Per ICD-10 Manual 2019, under section E03 (Other Hypothyroidism), there is an “Excludes 1 Note” E89.0 (Postprocedural hypothyroidism) and E00-E02 (Iodine-deficiency related hypothyroidism); as these 2 diagnoses represent mutually exclusive conditions with different origin and cannot be reported together.

Per the 2019 ICD-10 Manual page 1067, Chapter 19. Injury, Poisoning and Certain Other Consequences of External Causes lists T43- (Poisoning by, adverse effect of and underdosing of psychotropic drugs, not elsewhere classified) with an “Excludes 1 Note” for T42.4- (Poisoning by, adverse effect of and underdosing of benzodiazepines). As one is specific (“benzodiazepines”) and one is “not classified elsewhere” these two diagnoses are mutually exclusive and cannot be reported together.