MedicaidCoverageHigh impact
Newsletter Vol. 24, No.02
New Jersey Medicaid·NJ · Pediatrics, Family Medicine, Allergy & Immunology +1 more·Provider Notice
Effective date
Jul 1, 2014
We identified it
Jun 20, 2026
Summary
Effective July 1, 2014, NJ FamilyCare Plans B, C, and D will no longer have access to free vaccines through the NJ-VFC program. Providers must now obtain vaccines from traditional market sources and bill the managed care plans for both vaccine costs and administration fees. Only Plan A and Medicaid-eligible children retain NJ-VFC access.
Action Required
By June 30, 2014: Billing team must update all systems and processes to shift vaccine procurement from NJ-VFC to commercial vendors for NJ FamilyCare Plans B, C, and D members. Modify billing templates and claim submission procedures to include vaccine acquisition costs (not just administration fees) for all claims with service dates on or after July 1, 2014. Verify member eligibility using REVS (1-800-676-6562) to confirm plan type before service delivery. Clinical staff must verify NJ FamilyCare plan type at check-in. Update encounter forms to distinguish between Plan A (continues NJ-VFC access) and Plans B/C/D (requires commercial vaccine billing). Contact Molina Provider Services (1-800-776-6334) with questions. Failure to bill for vaccine costs will result in underpayment or claim denials for Plans B, C, and D members.