MedicaidPrior AuthMedium impact
CBHS/PFC/CSOCI Newsletter Vol. 03, No. 05
New Jersey Medicaid·NJ · Psychiatry·Prior Authorization
We identified it
Jun 20, 2026
Summary
New prior authorization requirements are being implemented for mental health services specifically for non-Medicaid/NJ FamilyCare-eligible individuals enrolled in the Partnership for Children (PFC) program who are transitioning out of Care Management Organization (CMO) services. This affects billing for mental health services in New Jersey.
Action Required
Immediately: Billing team must identify patients enrolled in NJ Partnership for Children (PFC) program who are transitioning out of CMO services and are not eligible for Medicaid/NJ FamilyCare. Implement prior authorization workflow for all mental health services for these specific patients. Update patient eligibility verification process to flag PFC transitional patients. Contact NJ MMIS for specific prior authorization procedures and required documentation.