N.J. Admin. Code § 10:73-3.25

Current through Register Vol. 56, No. 21, November 4, 2024

Section 10:73-3.25 - Reimbursement methodology for CMO services

(a) Claims for CMO services shall be submitted on a monthly fee-for-service basis for the care management component of the CMO's services.

1. The CMO shall bill for the first month that a beneficiary begins receiving services from the CMO, regardless of the specific initial date of services.

2. The CMO shall not bill for the month that a beneficiary ceases receiving services from the CMO, regardless of the specific discharge date.

(b) Providers shall seek reimbursement by submitting a CMS-1500 claim form to the Medicaid fiscal agent, in accordance with N.J.A.C. 10:49.

1. HCPCS code Z5008 shall be billed monthly for Care Coordination services provided by care management organizations, provided to beneficiaries eligible under the Children's System of Care. (See N.J.A.C. 10:73-5.2)

N.J. Admin. Code § 10:73-3.25

Recodified from N.J.A.C. 10:73-3.21 and amended by R.2006 d.421, effective 5/21/2007.
See: 38 N.J.R. 2585(a), 39 N.J.R. 2096(a).
Deleted (a); recodified (b) and (c) as (a) and (b); rewrote (a)1 and (a)2; in the introductory paragraph of (b), substituted "CMS" for "HCFA" and inserted "to the Medicaid fiscal agent"; and in (b)1, substituted "eligible under the DCBHS" for "as part of", deleted "Initiative" following "of Care", and updated the N.J.A.C. reference.

Amended by 53 N.J.R. 1492(a), effective 9/7/2021