MedicaidPrior AuthMedium impact
CBHS/PFC/CSOCI Newsletter Vol. 03, No. 02
New Jersey Medicaid·NJ · Psychiatry·Provider Notice
We identified it
Jun 20, 2026
Summary
New Jersey requires prior authorization for out-of-state inpatient psychiatric hospital services for Medicaid/NJ FamilyCare and Partnership for Children beneficiaries under age 21. Emergency admissions are exempt from prior authorization but require it for continued stays.
Action Required
Immediately: Billing team must obtain prior authorization from NJ Division of Medical Assistance and Health Services before admitting patients under 21 to out-of-state psychiatric hospitals. Submit requests to Office of Utilization Management including Admission Certification of Need, DSM-V diagnosis, treatment history, current medications, clinical status, treatment proposal, and attestation that NJ placement unavailable. Attach authorization letter to claims for reimbursement. For emergency admissions, attach physician's emergency attestation statement to claims.