MedicaidCoverageHigh impact
Newsletter Vol. 23, No.20
New Jersey Medicaid·NJ · Psychiatry·Provider Notice
Effective date
Jan 1, 2014
We identified it
Jun 20, 2026
Summary
New Jersey FamilyCare (NJFC) program expands effective January 1, 2014 to cover parents, single adults, and childless couples ages 19-64 at up to 133% Federal Poverty Level under a new Alternative Benefit Plan (ABP). The ABP replaces NJFC Plan G and Plan D for these populations and includes expanded mental health, substance abuse, and family planning services. Key differences: ABP beneficiaries have zero co-payments, mental health/substance abuse services are paid fee-for-service by NJFC regardless of HMO enrollment, and Error Code 380 will continue denying FFS claims that must route to HMOs.
Action Required
REQUIREMENTS:
By December 31, 2013: Billing team must update systems to recognize new NJFC Expansion Program/ABP eligibility codes and plan designations. Front desk staff must update patient intake forms to identify new eligible populations (parents above AFDC limits, single adults, childless couples ages 19-64).
Effective January 1, 2014:
- Update billing software to route all ABP mental health and substance abuse claims to FFS processing, NOT to HMOs, regardless of member HMO enrollment status
- Update co-payment collection rules: REMOVE all co-payment requirements for ABP beneficiaries (zero co-payment policy)
- Update claim submission rules to expect Error Code 380 denials when ABP-covered services (except mental health/substance abuse) are incorrectly submitted to FFS instead of routing to HMO
- Update eligibility verification protocols to distinguish between traditional NJFC Plans (A, B, C, D) and new ABP plan when verifying via REVS (1-800-676-6562) or eMEVS (www.njmmis.com)
- Billing team must contact appropriate NJFC HMO provider services (phone numbers provided in policy) to confirm practice network participation for ABP service delivery
Consequences of inaction: Claims for ABP beneficiaries will be denied without proper routing; collections efforts for co-payments on ABP plans will violate policy; mental health/substance abuse services routed to HMOs will be denied and require rework.