June 30, 2025
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June 30, 2025 NJAMHAA has been requesting an extension of the transition policies for the integration of outpatient behavioral health services to Medicaid managed care for some time and learned today that those policies are being extended, with a new requirement though. Prior authorization (PA) requests must now be submitted for all claims; they will continue to be automatically approved. Only if a PA request has been submitted will a claim be paid. Submission of PA requests will also ensure out-of-network claims will be paid at the Medicaid rates. See this slide, which shows these changes. All of the managed care organizations (MCOs) will continue to have trainings and office hours to assist providers in completing PAs correctly. They will also be providing feedback on individual PAs to let providers know when requests would not have met the medical necessity criteria. NJAMHAA will be sharing information on all the available MCO assistance soon. This extension is not only a great win, but it was one that was necessary and critically important to the fiscal stability of NJAMHAA members. We thank all the members who shared their billing issues with us, as that information strongly supported the request for an extension. |
