MedicaidPrior AuthHigh impact
Newsletter Vol. 18, No. 16
New Jersey Medicaid·NJ · Dentistry·Prior Authorization
Effective date
Jan 1, 2009
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid (NJ FamilyCare) revised prior authorization and billing procedures for dental services effective January 1, 2009. Federally Qualified Health Centers must now include the expected number of encounter visits in prior authorization requests for multi-visit dental procedures, and all dental claims must include both the dental procedure code and prior authorization number or face denial.
Action Required
By December 31, 2008: Billing team must implement the following changes for all NJ FamilyCare/Medicaid dental claims: (1) Update prior authorization submission process to require documentation of expected encounter visit counts for multi-visit procedures (crowns up to 3 visits, endodontics up to 5 visits, one denture up to 6 visits, two dentures up to 8 visits); (2) Modify billing system and claim submission templates to mandate inclusion of BOTH the approved dental procedure code AND the prior authorization number on every dental claim; (3) Train billing staff to deny claims internally before submission if missing either the prior authorization number or procedure code, or if the procedure code was not pre-authorized; (4) For in-progress multi-visit cases where encounter visits were not approved, implement process to submit new two-part prior authorization forms for remaining visits with reference to original approval numbers. Contact DMAHS Bureau of Dental Services at 609-588-7136 for pre-authorization questions and Unisys Provider Services at 1-800-776-6334 for claims issues. Failure to comply will result in automatic claim denials.