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