NJ Medicaid FFS

Effective January 1st 2025, NJ Medicaid will be shifting behavioral health services from FFS(fee for service) to MCOs(managed care organizations). MCOs will be responsible for coordinating care and managing payments, rather than providers billing Medicaid directly. The main 5 MCOs are Aetna, Horizon NJ, United Healthcare Community Plan, Wellpoint and Fidelis. The process to credential providers through the MCOs has begun. You can get more information and credentialing contacts here: https://www.nj.gov/humanservices/dmhas/information/stakeholder/DMAHS_BHI/MCO%20BH%20Contact%20Resource%20Guide%20for%20Providers_7.22.2024.xlsx

My podcast episode with Leaders in Medical Billing

Updated UBH/United/Optum Supervisory billing policy

Updated Claim Submission Requirements for Optum Patients Receiving Supervisory Services Effective Oct. 1, 2024, Optum will reimburse outpatient supervisory services claims covered by Commercial Behavioral Health plans as follows: California, Colorado, Iowa & Massachusetts – Both network and out-of-network providers and groups ALL other states – Only network providers and groups who have an existing, fully executed participation agreement on or before Sept. 30, 2024.