All PlansAdministrativeHigh impact
Newsletter Vol. 33, No.02
New Jersey Medicaid·NJ·Provider Notice
We identified it
Jun 20, 2026
Summary
This policy update clarifies that services provided by excluded, unlicensed, or uncertified individuals or entities will not be covered or reimbursed. Billing teams must verify provider credentials and certification status before submitting claims to avoid denials.
Action Required
Immediately: Billing team must implement verification process to check all provider licenses, certifications, and exclusion status before claim submission. Update credentialing checklist and verify current providers against OIG exclusion database. Claims from excluded or unlicensed providers will be denied and may trigger compliance issues.