MedicaidAdministrativeHigh impact
Newsletter Vol. 17, No. 03
New Jersey Medicaid·NJ·Provider Notice
Effective date
Apr 1, 2007
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid is mandating automatic enrollment of non-dually eligible Aged, Blind and Disabled (ABD) beneficiaries into HMOs in Atlantic, Gloucester, Sussex, and Warren Counties effective April 1, 2007. Providers must verify they are contracted with participating Medicaid HMOs to continue serving these patients, as enrollment in a specific HMO determines provider network access.
Action Required
By March 1, 2007: Billing team and providers must verify participation in at least one of the five contracted Medicaid HMOs (AmeriChoice, AMERIGROUP, Health Net, Horizon NJ Health, or University Health Plans) in Atlantic, Gloucester, Sussex, and Warren Counties. Contact each HMO's provider services line to confirm current network status or submit provider applications if not contracted. Update patient eligibility verification system to confirm HMO enrollment before scheduling. Inform all front desk and eligibility staff that ABD Medicaid patients in these counties must now be enrolled in an HMO to receive Medicaid-covered services. After April 1, 2007, patients without voluntary HMO selection will be auto-assigned; confirm their assigned HMO before billing claims. Failure to verify HMO network participation will result in claim denials for patients whose assigned HMO does not include your practice in its provider network.