MedicaidPrior AuthMedium impact
Newsletter Vol. 20, No.19
New Jersey Medicaid·NJ · Orthopedics, General Practice·Prior Authorization
Effective date
Sep 1, 2010
We identified it
Jun 20, 2026
Summary
NJ Medicaid/NJ FamilyCare is clarifying prior authorization form submission requirements for medical suppliers and prosthetics/orthotic providers. Providers must accurately report the total fee requested (total charge for all units or days of service) in Fields 14I and 17I on forms FD-287, FD-354, and FD-357, calculated as quantity × per-unit cost without dollar signs. This is a reminder of existing requirements, not a new policy change.
Action Required
Immediately: Billing team must audit all pending and submitted prior authorization requests on FD-287, FD-354, and FD-357 forms to ensure Fields 14I and 17I contain correctly calculated total fees (quantity × unit price). For example: 5 units at $5.00 per unit must be reported as 25.00, not 5.00. Remove any dollar signs from reported amounts. Implement internal verification process to confirm providers are calculating and reporting total charges correctly before form submission to Molina Medicaid. Flag any submitted forms with incorrect total fee calculations for resubmission. If clarification is needed, contact Molina Medicaid Healthcare Solutions Provider Services at (800) 776-6334.