MedicaidAdministrativeHigh impact
Newsletter Vol. 9, No. 19
New Jersey Medicaid·NJ·Provider Notice
Effective date
Apr 1, 1999
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid and NJ KidCare fee-for-service providers must ensure all employees, contractors, and subcontractors rendering healthcare services are properly licensed/certified and meet all program requirements. Providers cannot bill for services that fail to meet these standards and must repay any improper reimbursements, with potential civil or criminal penalties.
Action Required
Immediately: Billing team and providers must conduct a compliance audit of all employees, contractors, and subcontractors providing Medicaid and NJ KidCare fee-for-service services. Verify current licensure and certification status for all individuals and entities. Do NOT submit claims for services rendered by unlicensed or uncertified personnel or entities, or services using unlicensed/uncertified equipment or vehicles. Implement a credentialing verification process before engaging any new contractors or subcontractors. Document all verification results in compliance files. Any claims already submitted for non-compliant services must be identified and reimbursed to the Division immediately. Update billing software and intake procedures to block claims from uncredentialed service providers.