MedicaidAdministrativeMedium impact
Newsletter Vol. 11, No. 52
New Jersey Medicaid·NJ·Provider Notice
Effective date
Jun 1, 2001
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid will no longer accept retroactive eligibility applications using Form FD-74 dated before November 1995. Applicants must use the current form and resubmit with required documentation within 30 days, or their retroactive Medicaid claims will not be processed.
Action Required
Immediately: Billing team must verify that any New Jersey Medicaid patients seeking retroactive coverage are using Form FD-74 dated November 1995 or later. For patients with older forms, direct them to contact the Retroactive Eligibility Unit at (609) 588-2835 or visit Medical Assistance Customer Centers to obtain current forms. Hold claims for retroactive periods until updated eligibility is confirmed, as outdated forms will not be processed.