N.J. Admin. Code § 10:54-3.3

Current through Register Vol. 56, No. 19, October 7, 2024

Section 10:54-3.3 - Authorization of reimbursement for out-of-State hospital services

(a) A request for authorization for reimbursement for out-of-State hospital services shall be directed to the Medical Assistance Customer Center (MACC) in the area where the beneficiary resides (see N.J.A.C. 10:49, Appendix), except that:

1. Prior authorization of out-of-State psychiatric services shall be directed to the Office of Utilization Management, Mental Health Services Unit, and shall comply with the requirements of 10:54-7.4.

(b) If authorized, the authorization letter of a medical consultant of the New Jersey Medicaid/NJ FamilyCare program will be forwarded to the attending physician and the Medicaid/NJ FamilyCare program beneficiary. When submitting the claim for service to the Medicaid/NJ FamilyCare fiscal agent, the physician shall enter the authorization number on the claim.

N.J. Admin. Code § 10:54-3.3

Amended by R.2001 d.51, effective 2/5/2001.
See: 32 N.J.R. 3929(a), 33 N.J.R. 555(a).
In (a), substituted "Medical Assistance Customer Center (MACC)" for "Medicaid District Office (MDO)" preceding "in the area" and substituted "beneficiary" for "recipient" preceding "resides" in the introductory paragraph; in (a)1, substituted "Utilization Management" for "Health Services Administration" preceding ", Mental Health Services Unit,".
Amended by R.2012 d.124, effective 7/2/2012.
See: 43 N.J.R. 1477(a), 44 N.J.R. 1884(a).
Deleted former (b), recodified (c) as (b); and in (b), inserted the first and third occurrences of "/NJ FamilyCare", inserted "and the Medicaid/NJ FamilyCare program beneficiary", and substituted "enter the authorization number on" for "attach the authorization letter to".