MedicaidCoverageHigh impact
Newsletter Vol. 29, No.13
New Jersey Medicaid·NJ·Eligibility
Effective date
Oct 1, 2019
We identified it
Jun 20, 2026
Summary
Effective October 1, 2019, Long Term Residential (LTR) services for three NJ FamilyCare sub-populations (Division of Developmental Disabilities, Managed Long Term Services and Supports, and Fully Integrated Dual Eligible Special Needs Plans) will transition from fee-for-service to managed care reimbursement. Providers must contract with managed care organizations; fee-for-service payment will no longer be available for these populations after the effective date.
Action Required
By September 30, 2019: Providers treating NJ FamilyCare beneficiaries in the Division of Developmental Disabilities (DDD), Managed Long Term Services and Supports (MLTSS), or Fully Integrated Dual Eligible Special Needs Plans (FIDE-SNP) must establish contracts with at least one managed care organization (Aetna Better Health of New Jersey, AMERIGROUP New Jersey, Horizon NJ Health, UnitedHealthcare Community Plan, or WellCare). Billing team must: (1) contact managed care plan provider relations departments at the provided URLs; (2) complete credentialing applications; (3) update billing system to route LTR claims for these three populations to the contracted managed care plan instead of NJ FamilyCare fee-for-service; (4) train billing staff on managed care billing requirements and prior authorization processes for each plan. After October 1, 2019, fee-for-service claims for LTR services for DDD, MLTSS, and FIDE-SNP members will be denied. For questions, contact NJ DMAHS Office of Customer Service at 609-631-4641.