MedicaidAdministrativeHigh impact
Newsletter Vol. 18, No. 17
New Jersey Medicaid·NJ·Provider Notice
Effective date
Jan 1, 2009
We identified it
Jun 20, 2026
Summary
New Jersey is mandating automatic enrollment of non-dually eligible Aged, Blind, and Disabled (ABD) Medicaid clients in HMOs across Hudson, Hunterdon, Somerset, and Union Counties effective January 2009. Providers must verify participation in contracted Medicaid HMO networks to continue serving affected patients, as patients can only receive services through providers in their enrolled HMO's network.
Action Required
By December 16, 2008: Billing team must verify and document which of the five Medicaid HMOs (AmeriChoice, AMERIGROUP, Health Net, Horizon NJ Health, University Health Plans) the practice participates in within each of the four affected New Jersey counties. Contact each HMO's provider services line to confirm active participation or submit provider applications if not currently contracted. Update billing system to flag all ABD Medicaid patients in these counties and route claims to the correct HMO network based on patient enrollment. Ensure front desk staff can identify which HMO each patient is enrolled in at time of service. After January 1, 2009: Deny service or obtain valid HMO authorization before providing care to any ABD Medicaid patient from these counties not enrolled in a contracted HMO at your practice, as claims submitted outside the patient's assigned HMO network will be denied.