MedicaidPrior AuthHigh impact
Newsletter Vol. 32, No.14
New Jersey Medicaid·NJ·Prior Authorization
Effective date
Jul 15, 2022
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid/NJ FamilyCare is reinstating prior authorization requirements effective July 15, 2022, after a COVID-19 suspension. All claims for services delivered on or after this date without prior authorization will be denied. Providers must resume submitting PA requests immediately to allow adequate processing time before the effective date.
Action Required
By July 15, 2022: Billing team must immediately resume submitting prior authorization requests for all NJ Medicaid/NJ FamilyCare services. Update billing system to re-enable prior authorization edits and denials for claims without PA approval. Identify all services and procedures that require PA under current guidance. Audit any pending claims with service dates on or after July 15, 2022 to ensure prior authorization is obtained before billing. Contact Gainwell Technologies Provider Services at 1-800-776-6334 with billing questions or the Division of Medical Assistance Office of the Medical Director at 609-631-4642 for policy questions. NOTE: Provider groups and services that were required to continue PA during the pandemic should verify they are following current guidance. Failure to obtain prior authorization will result in automatic claim denials regardless of service date.