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Newsletter Vol. 21, No.19
New Jersey Medicaid·NJ · Physical Therapy, Occupational Therapy, Speech Therapy +1 more·Eligibility
Effective date
Jul 1, 2011
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid is mandatorily enrolling most Medicaid recipients into managed care plans effective July 1, 2011. Previously, individuals with cystic fibrosis were incorrectly stated as excluded; this newsletter corrects that error and clarifies that only those with cystic fibrosis program status code 760 are excluded. Additionally, Medicaid HMO plans now provide home health, pharmacy, therapy services, and medical day care, while non-emergent medical transportation moves to LogistiCare Solutions and Medicare Part D co-payment coverage ends.
Action Required
By July 1, 2011: Billing team must update patient records to identify which Medicaid patients are assigned to managed care plans (Amerigroup, Healthfirst, Horizon NJ Health, or United Healthcare Community Plan) versus those excluded from enrollment. Verify network participation with each managed care provider using the listed phone numbers. Update billing software to route claims to the correct managed care plan based on patient assignment. Front desk staff must inform patients of their assigned managed care plan and provide member services contact information. Billing team must stop billing non-emergent medical transportation claims to Medicaid HMO plans and redirect to LogistiCare Solutions. Immediately update claim submission rules to remove Medicare Part D pharmacy co-payment coverage for Medicaid beneficiaries. Verify that home health, pharmacy, therapy (physical, occupational, speech), and medical day care services are now included in managed care plan coverage and adjust prior authorization workflows accordingly. Failure to route claims to correct managed care plans will result in claim denials.