MedicaidReimbursementMedium impact
Newsletter Vol. 35, No.06
New Jersey Medicaid·NJ · Geriatrics·Reimbursement
Effective date
Jan 1, 2025
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid now allows Assisted Living Program (ALP) providers to bill Fee-for-Service during enrollment gaps, expanding previous coverage that only applied to facility-based assisted living. Providers must request Special Program Code 62 assignment through a monthly Excel submission process to receive reimbursement for eligible members pending MCO enrollment.
Action Required
Immediately: Assisted Living providers in New Jersey must submit monthly Excel spreadsheets to mahs.provider-inquiries@dhs.nj.gov requesting SPC 62 assignment for eligible members pending MCO enrollment. Include member name, DOB, Medicaid ID, county, financial/clinical eligibility dates, facility name, and approval request date. Allow 10 business days for processing before billing using codes Y9634 (ALP), Y9633 (ALR), or Y7574 (CPCH). Retroactive billing allowed back to January 1, 2025.