MedicaidAdministrativeHigh impact
Medicaid Alert MA-2026-03
New Jersey Medicaid·NJ·Provider Notice
Effective date
Jun 1, 2026
We identified it
Jun 20, 2026
Summary
Effective June 1, 2026, New Jersey Medicaid will implement new claims edits that pend or deny claims submitted for services rendered when a provider's required license is expired, inactive, suspended, or invalid. Billing teams must verify all providers' licensure information is current in the NJMMIS system and submit updated licenses to Gainwell Provider Enrollment if not listed, or claims will be denied after a 4-week pend period.
Action Required
By May 31, 2026: Billing team must verify all servicing, billing, attending, prescribing, supervising, and operating providers have current license information on file in NJMMIS (access at NJMMIS.com). For any provider requiring licensure whose name and NPI are NOT listed on the valid licenses file, immediately submit a copy of their current license to Gainwell Provider Enrollment via secure email (NJmmisProviderEnrollment@GainwellTechnologies.com), fax (1-609-584-1192), or mail (Provider Enrollment Unit, Gainwell Technologies, PO Box 4804, Trenton, NJ 08650). Include the provider's NPI and NJ Medicaid ID on all submissions. Allow up to 2 weeks for updates to reflect in the system. Beginning June 1, 2026, claims submitted for services on dates when a provider's license is not current will pend under error codes 1031-1037 for up to 4 weeks while licensure is updated; pended claims do not require resubmission and will reprocess weekly automatically. If licensure is not updated within 4 weeks, claims will be denied. Failure to update licenses will result in claim payment delays and denials.