MedicaidPrior AuthMedium impact
Newsletter Vol. 18, No. 12
New Jersey Medicaid·NJ·Prior Authorization
Effective date
Oct 1, 2008
We identified it
Jun 20, 2026
Summary
Effective October 1, 2008, New Jersey Medicaid is discontinuing the LD-25 form for out-of-state hospital prior authorizations. Instead, providers will receive a Provider Notification Letter (FD360) with a 10-digit prior authorization number that must be entered in block 63 on UB92/UB04 claims.
Action Required
By October 1, 2008: Out-of-state hospitals must update billing procedures to use the new 10-digit prior authorization number from Provider Notification Letter (FD360) instead of attaching LD-25 forms. Enter PA number in block 63 on UB92/UB04 claims or equivalent field on 835a electronic transactions. Continue contacting MACC for prior authorization approvals.