MedicaidPrior AuthHigh impact
CBHS/PFC/CSOCI Newsletter Vol. 03, No. 05
New Jersey Medicaid·NJ · Psychiatry, Pediatrics·Prior Authorization
Effective date
Oct 1, 2003
We identified it
Jun 20, 2026
Summary
Effective October 1, 2003, mental health services provided to non-Medicaid/NJ FamilyCare-eligible children (ID numbers beginning with '3560') who are transitioning out of Care Management Organization services under the Partnership for Children program now require prior authorization numbers from ValueOptions before service delivery. Providers must obtain prior authorization by calling ValueOptions at 1-877-652-7624 and must enter the authorization number in Box #23 of the CMS 1500 claim form or claims will be denied.
Action Required
By October 1, 2003: Billing team and mental health providers must implement the following: (1) Update internal workflows to require prior authorization contact with ValueOptions (1-877-652-7624) BEFORE rendering any mental health services to PFC-enrolled children with ID numbers beginning with '3560'; (2) Modify claim submission procedures to ensure the prior authorization number is entered exactly as it appears on the authorization letter in Box #23 of the CMS 1500 claim form; (3) Train front desk and verification staff to ALWAYS verify beneficiary eligibility using REVS (1-800-676-6562) before rendering services and check PFC identification cards to identify '3560' beneficiaries; (4) If a Youth Case Manager is coordinating care, establish process to request prior authorizations through the YCM rather than directly with the provider. CONSEQUENCES: Claims submitted without prior authorization numbers for '3560' beneficiaries will be rejected with Error Code 423 (authorization number required). Claims with incorrect prior authorization numbers will deny with Error Code 774 (PA number not on file). For billing questions, contact Unisys Provider Services at 1-800-776-6334.