Newsletter Vol. 4, No. 41

Immediately: Billing team must implement Second Surgical Opinion verification protocol for all New Jersey Medicaid claims involving: (1) elective hysterectomies, (2) spinal fusion procedures, (3) laminectomy procedures, (4) unilateral or bilateral hernia repairs (age 65+), and (5) tonsillectomy/adenoidectomy (except primary adenoidectomy for children under specified age). Verify that operating physicians have obtained second opinions BEFORE submitting claims. For urgent/emergent surgeries, require physician attestation statement attached to claim form. For anesthesiologists and assistant surgeons, NO Medicaid Second Surgical Opinion Referral Form (FD) is required. Update encounter forms and billing system checklists to flag these procedure types. Communicate age-based exceptions to providers (e.g., hernia repair exemption for patients under 65; spinal fusion/laminectomy exemption for pediatric scoliosis cases). Route questions to Unisys Second Opinion Referral Center. Failure to verify second opinion compliance will result in claim denials.