N.J. Admin. Code § 10:60-5.7

Current through Register Vol. 56, No. 24, December 18, 2024

Section 10:60-5.7 - Payment for EPSDT/PDN

(a) Claims for payment for PDN services shall be submitted on the CMS 1500 Claim Form. The PA number shall be noted on the claim form. Providers shall bill each date of service on a separate line (FIELD 24A) of the claim form. If more than one procedure code is billed for the same date of service, separate lines shall be used when billing each procedure code. Providers shall not span dates of service on a line of the claim form.

1. Private duty nursing provider charges may vary but reimbursement cannot exceed the maximum rates allowed by the DMAHS in accordance with N.J.A.C. 10:60-11.2(e).

(b) EPSDT/PDN providers shall submit to DMAHS, with each prior authorization request, comprehensive clinical summaries reflecting beneficiaries' medical status and need for ongoing services. DMAHS staff shall review the submitted clinical data and may conduct on-site home visits before reauthorizing PDN services. In addition, DMAHS staff shall perform Home Care Quality Assurance Reviews of these individuals. In accordance with N.J.A.C. 10:60-1.9, DMAHS shall continue on-site monitoring of private duty nursing agencies to review compliance with this chapter.

N.J. Admin. Code § 10:60-5.7

Amended by 50 N.J.R. 1992(b), effective 9/17/2018