New Jersey: Updated codes for early elective delivery prior authorization

As a follow-up to the Early elective delivery (EED) reimbursement changes effective Jan. 1, 2021, more codes are now eligible for reimbursement for services back to Jan. 1, 2021.

Prior authorization
Scheduled EEDs under 39 weeks of gestation due to medical necessity require an approved prior authorization or submitted notification.

For information on how to submit electronically, visit UHCprovider.com/paan or call Provider Services at 888-362-3386, Monday through Friday, 8 a.m. to 6 p.m.

Claim submissions
Obstetricians, midwives, hospitals and clinics requesting New Jersey Family Care (NJFC) Medicaid reimbursement for a labor and delivery claim are required to report an ICD-10-CM diagnosis code indicating the week of gestation (ICD-10-CM category code Z3A). Claims submitted without a diagnosis code indicating the week of gestation will be denied by the NJFC Medicaid Program. 

Any claim reporting a week of gestation ICD-10-CM diagnosis code of less than 39 weeks without one of the following diagnosis codes will also be denied: O10, O11, O12, O13, O14, O15, O16, O24, O30, O31, O33, O35, O36, O42, O43, O44, O45, O71 or R03. 

Questions?

Call Provider Services at 888-362-3368, Monday through Friday, 8 a.m. to 6 p.m.

PCA-1-21-02272-C&S-News_07132021