MedicaidAdministrativeHigh impact
Medicaid Alert - MA-2003-01
New Jersey Medicaid·NJ · Psychiatry, Emergency Medicine, Pediatrics·Provider Notice
Effective date
Mar 1, 2003
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid has identified a system error causing emergency room claims for mental health services provided to Partnership for Children enrollees to be incorrectly denied for lack of prior authorization. Effective immediately, all such ER mental health claims must be submitted via hard copy directly to the Division of Medical Assistance and Health Services. Previously denied claims (edit 423) must also be resubmitted with original signatures for expedited processing.
Action Required
IMMEDIATELY: Billing team must identify all emergency room mental health service claims for Partnership for Children enrollees and route these claims as hard copies (with original signatures) to: Division of Medical Assistance and Health Services, Office of Utilization Management – Mental Health Unit, PO Box 712 Mail Code 15, Trenton, NJ 08625-0712. Do NOT submit these claims electronically to Unisys. Prior to this change, verify your billing system can identify Partnership for Children enrollment status and flag ER mental health claims for manual hard-copy submission. Billing team must also review any previously denied claims with edit 423 (lack of prior authorization) for mental health services to Partnership for Children members and resubmit those claims as hard copies with original provider signatures to the Division address above. This is a temporary workaround; the Division is working on a permanent system fix. Contact the Office of Utilization Management at (609) 588-2721 with questions.