MedicaidPrior AuthHigh impact
Newsletter Vol. 13, No. 07
New Jersey Medicaid·NJ · Psychiatry·Prior Authorization
Effective date
Feb 1, 2003
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid has reduced the prior authorization threshold for partial hospitalization services from 90 days to 30 days, effective immediately. After the initial 30-day treatment period, prior authorization is now required for the beneficiary's lifetime for NJFC Plans A-D and Plan I beneficiaries.
Action Required
Immediately: Billing team must update prior authorization tracking system to flag partial hospitalization services after 30 days instead of 90 days for New Jersey FamilyCare Plans A-D and Plan I beneficiaries. Contact DMAHS Mental Health Unit at (609) 588-2749 for questions. Update scheduling systems to prompt for prior auth requests at day 31. Claims submitted without required prior authorization after 30 days will be denied.