MedicaidAdministrativeHigh impact
Newsletter Vol. 23, No.06
New Jersey Medicaid·NJ·Coding
Effective date
Jan 1, 2013
We identified it
Jun 20, 2026
Summary
Effective January 1, 2013, New Jersey Medicaid/NJ FamilyCare now recognizes physician assistants as 'non-billing' providers. Physician assistants may be enrolled and their NPIs reported on claims for services they refer, order, or prescribe. However, PAs cannot bill independently and cannot serve as attending or operating practitioners. Billing procedures vary by claim form type (UB-04, CMS-1500, pharmacy, and TAD).
Action Required
REQUIREMENTS:
- Effective January 1, 2013: Billing team must update claim submission procedures based on claim form type:
• UB-04 (hospital claims): Continue reporting supervising physician NPI in field 76 (attending) or field 77 (operating). Claims reporting PA NPI in these fields will be denied.
• CMS-1500 claims: Report PA NPI in field 17b when services are referred, ordered, or prescribed by a PA.
• Pharmacy claims: Report PA NPI for prescriptions prescribed by a PA.
• TAD (nursing facility claims): Report supervising physician NPI in field 39 (attend NPI).
- Providers and billing staff must verify PA enrollment status before submission via secure portal at www.njmmis.com or contact Molina at 609-588-6036.
- For pharmacy services: Implement 15-day grace period process for non-enrolled PAs (up to 30-day medication supply eligible during grace period).
- Educate providers that PAs cannot independently bill and are not required to treat Medicaid/NJFC beneficiaries.
- Update billing system validation rules to prevent PA NPIs in UB-04 fields 76/77 and enforce correct field placement per claim type.
- Consequence: Claims with incorrect NPI reporting (PA NPI in hospital attending/operating fields) will be denied payment.