MedicaidPrior AuthHigh impact
Newsletter Vol. 9, No. 23
New Jersey Medicaid·NJ · Psychiatry·Coding
Effective date
Apr 1, 1999
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid and NJ KidCare requires prior authorization for partial hospitalization services after the first 90 calendar days of treatment. Providers must exclude meal time and transportation when calculating minimum hour requirements for billing full-day (5+ hours) or half-day (3+ hours) partial hospitalization services.
Action Required
Immediately: Billing team must implement prior authorization tracking for partial hospitalization services after 90 days of treatment using forms FD-07 and FD-07A submitted to Division of Medical Assistance. Update billing system to exclude meal time and transportation when calculating active programming hours for full-day (minimum 5 hours) and half-day (minimum 3 hours) services. Failure to comply may result in payment recovery, provider suspension, or disqualification from Medicaid programs.