MedicaidAdministrativeHigh impact
Newsletter Vol. 10, No. 73
New Jersey Medicaid·NJ·Provider Notice
Effective date
Sep 1, 2000
We identified it
Jun 20, 2026
Summary
New Jersey launches NJ FamilyCare program effective September 1, 2000, providing comprehensive managed care health coverage through HMOs for approximately 125,000 low and moderate-income residents. Billing teams must process claims differently based on four plan designations (A-D), with Plan A offering fee-for-service until HMO enrollment and Plans B-D operating exclusively through managed care. Identification numbers for WFNJ/GA converted beneficiaries will change effective November 1, 2000, requiring claims submission updates.
Action Required
REQUIREMENTS:
• By October 1, 2000: Billing team must update systems to recognize four NJ FamilyCare plan designations (A, B, C, D) from identification cards and route claims accordingly—Plan A claims to both fee-for-service and HMOs until enrollment; Plans B-D exclusively to HMOs.
• By October 1, 2000: Configure billing software to apply copayment rules correctly: Plans A and B have NO copayments; Plan C and D copayments apply only in managed care (not fee-for-service except Plan D mental health).
• By November 1, 2000: Update system to recognize converted WFNJ/GA beneficiary identification numbers with new format (XX70XXXX where XX=county 01-21). Submit all claims with service dates on or after November 1, 2000 under new identification numbers; continue using old WFNJ/GA numbers for September-October 2000 service dates.
• Immediately: Train billing and front desk staff to recognize NJ FamilyCare identification cards issued monthly and verify Plan designation before processing claims.
• By October 1, 2000: Establish separate claim submission pathways: fee-for-service claims to Unisys (State's fiscal agent); managed care claims to appropriate HMO per member enrollment county.
• Effective September 1, 2000: For WFNJ/GA single individuals and couples without dependent children under 19: process hospital services on fee-for-service basis through September 30, 2000; transition to HMO claims processing November 1, 2000 forward.
• Immediately: Update internal policies to note that Plan A beneficiaries receive anti-retroviral drugs fee-for-service until managed care enrollment or ADDP enrollment; Plan D and WFNJ/GA Plan A (identified by '70' in positions 3-4 of ID) receive AIDS medications fee-for-service even after HMO enrollment until ADDP enrollment.
• Before October 1, 2000: Verify billing system processes PE (Presumptive Eligibility) certifications—claims from September 2000 PE certifications should not be submitted until after October 1, 2000; pharmacy coverage for PE began October 1, 2000.
FAILURE TO IMPLEMENT: Claims will be denied if submitted under incorrect identification numbers, routed to wrong payers, or processed with incorrect copayment rules.