New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 73 - CASE MANAGEMENT SERVICES
Subchapter 3 - CARE MANAGEMENT ORGANIZATION SERVICES
Section 10:73-3.25 - Reimbursement methodology for CMO services
Universal Citation: NJ Admin Code 10:73-3.25
Current through Register Vol. 56, No. 18, September 16, 2024
(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)
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