MedicaidAdministrativeMedium impact
Newsletter Vol. 23, No.16
New Jersey Medicaid·NJ · Psychiatry·Coding
Effective date
Jan 1, 2013
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid now requires social workers (LCSWs, LSWs, CSWs) who refer patients to enroll as 'non-billing' providers and obtain NPIs. Billing providers must include the social worker's NPI on claims for referred services to receive payment.
Action Required
For claims with service dates on or after January 1, 2013: Billing team must collect NPIs from referring social workers and include them on all applicable claims. On CMS 1500 forms, report in Fields 17, 17a, and 17b. On UB-04 forms, report in Fields 78 and 79. For electronic claims, include NPI in appropriate transaction loops (2420F, 2310A for 837P; 2310F or 2420D for 837I). Social workers must enroll using Form FD-20B. Claims for services referred by non-enrolled social workers will not be paid.