MedicaidAdministrativeHigh impact
Newsletter Vol. 31, No. 09
New Jersey Medicaid·NJ·Reimbursement
Effective date
Jan 1, 2021
We identified it
Jun 20, 2026
Summary
New Jersey requires all Personal Care Assistance (PCA) providers billing Medicaid/NJ FamilyCare to implement Electronic Visit Verification (EVV) technology effective January 1, 2021, with escalating compliance thresholds through June 2021 (20%-90% of claims verified). Providers must integrate with HHAeXchange or approved third-party EVV systems and meet monthly compliance targets or risk losing new referrals and claim payment.
Action Required
REQUIREMENTS:
- By January 1, 2021 (already passed; current compliance status critical): All PCA providers in NJ must have completed EVV system integration and be actively submitting verified visit data. Billing team must verify provider has selected EVV solution (HHAeXchange, CareBridge, or approved third-party system).
- Immediately (April 2021 forward): Billing team must monitor and track EVV compliance rates monthly against DMAHS thresholds: April 2021 = 60%, May 2021 = 75%, June 2021 = 90% verified visit rate. Maintain compliance documentation for each payer (FFS Medicaid, Aetna, Horizon, UnitedHealthCare Community Plan, WellCare, Amerigroup).
- By May 15, 2021: Prepare for MCO notifications regarding at-risk compliance status. Review provider at-risk notices and implement corrective action plans before July 1, 2021 deadline.
- Before July 1, 2021: Ensure all PCA claims meet 100% EVV verification requirement or risk claim denials and loss of new member referrals from MCOs.
- Ongoing: For providers using third-party EVV systems, confirm integration with both HHAeXchange (for FFS/Aetna/Horizon/UnitedHealthCare/WellCare) and CareBridge (for Amerigroup/Horizon) per EDI specifications. Non-compliance will result in claim payment denials and loss of provider standing.