MedicaidPrior AuthHigh impact
CBHS/PFC/CSOCI Newsletter Vol. 03, No. 01
New Jersey Medicaid·NJ · Psychiatry, Pediatrics·Prior Authorization
Effective date
Apr 1, 2002
We identified it
Jun 20, 2026
Summary
ValueOptions now issues prior authorization numbers for mental/behavioral health services included in Individual Service Plans (ISPs) for children enrolled in Care Management Organizations (CMOs) in New Jersey. Providers must ensure the correct Medicaid/NJ FamilyCare Provider ID number is communicated to the CMO during ISP development and matches the authorization letter, or claims will be denied. Claims must include the authorization number, correct provider ID, and HCPCS codes to receive reimbursement.
Action Required
Immediately: (1) Billing team must verify that all providers submitting claims for CMO-enrolled children have communicated their correct Medicaid/NJ FamilyCare Provider ID number(s) to the respective CMOs in writing during ISP development. (2) Providers must use the Provider Billing Information Form (included in policy) to supply: provider name/agency, contact person, billing address, service provider name, service type, service location, and the specific Medicaid/NJ FamilyCare Provider ID for each service/program/site. (3) Billing staff must reconcile authorization letters received from ValueOptions to ensure the Provider ID matches the ID used in the ISP—if discrepancies exist, contact ValueOptions Client/Provider Services immediately at 1-877-652-7624. (4) When filing claims, billing team must enter: (a) the correct Medicaid/NJ FamilyCare Provider ID number for the authorized service, (b) the authorization number from ValueOptions/CMO, and (c) the HCPCS codes for services rendered. Failure to use the correct Provider ID or authorization number will result in claim denial and payment suspension. Before April 2002 claims: No action required. All subsequent claims: Verify prior authorization is in place before billing.