MedicaidAdministrativeMedium impact
Newsletter Vol. 21, No.09
New Jersey Medicaid·NJ·Coding
We identified it
Jun 20, 2026
Summary
New billing instructions have been issued for submitting claims to the fiscal agent for fee-for-service reimbursement of Medicaid/NJ FamilyCare covered services that are carved out of managed care plans. This affects how providers bill for certain Medicaid services that are not included in the standard managed care benefit package.
Action Required
Immediately: Billing team should review the full policy document at https://www.njmmis.com/documentDownload.aspx?document=21-09.pdf to understand specific billing requirements for Medicaid/NJ FamilyCare carved-out services. Update billing procedures to ensure claims for fee-for-service carved-out benefits are submitted to the correct fiscal agent rather than managed care plans.