New Jersey

State behavioral health guidelines and updates due to COVID-19

State-specific guidelines

NJ Insurance regulators have ordered insurance companies to expand use of telehealth services effective 3/10/2020. No other specific requirements have been provided.

Effective 3/22/2020

Commercial insurance companies are being required to:

  1. Review their telemedicine and telehealth networks to ensure adequacy and grant any requested in-plan exceptions for individuals to access out-of-network telehealth providers if network telehealth providers are not available, including, but not limited to, mental health and behavioral health providers.
  2. Rates of payment to in-network providers for services delivered via telemedicine or telehealth are not lower than the rates of payment established by the carrier for services delivered via traditional (i.e., in-person) methods.
  3. Notify providers of any instructions that are necessary to facilitate billing for telehealth services.
  4. Allow for telephonic telehealth services and flexibility in the specific technology used to deliver the services.
  5. Eliminate (may not impose) prior authorization requirements on medically necessary treatment that is delivered via telemedicine or telehealth.
  6. Disseminate information on their website, or other reasonable means, to notify individuals of these updates.
  7. Effective 3/20/2020

    Regulatory requirements for healthcare professionals licensed in other jurisdictions to become licensed in New Jersey and offer services to New Jersey residents, including telemedicine and telehealth services will be waived. Individuals who hold current healthcare licenses and certifications in good standing in other jurisdictions, and have been practicing within the last five years, will be able to secure New Jersey licenses by completing an Accelerated Licensing Application.

Understanding new Commercial Payer guidelines

Many commercial payers have also issued important updates explaining their expansion of telehealth services. While expanded coverage includes more services, looser restrictions put the responsibility on the provider to determine appropriate services. This shift can significantly increase the risk of payer denials later on. An informed interpretation of these new guidelines is essential to avoid issues with your revenue cycle in the coming weeks. We are available to further discuss our findings and analysis with you. To learn more about recent updates regarding commercial payer guidelines, please contact us directly.