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New Jersey MedicaidMedicaid · Coverage · Provider Notice · NJ · Pediatrics, General PracticeHigh impact

Newsletter Vol. 8, No. 07

Act
by Feb 1, 1998
Effective date
Feb 1, 1998
Identified
Jun 20, 2026

Summary

New Jersey implements Plan A of the NJ KidCare program effective February 1, 1998, expanding Medicaid eligibility for uninsured children under 19 with family income at or below 133% of federal poverty level. Eligible children will receive comprehensive managed care benefits through participating HMOs (same as New Jersey Care 2000) with no copayments, plus fee-for-service coverage for certain specialty services like mental health and nursing facility care. Billing teams must recognize dual identification cards (State Eligibility ID + HMO ID) and route claims appropriately between HMOs and UNISYS (fiscal agent for FFS services).

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What to do

by Feb 1, 1998 · 8 steps
01Billing team must update systems to recognize NJ KidCare Plan A eligibility and process claims through participating HMOs listed in policy attachment.
02Configure billing software to route mental health, substance abuse, nursing facility, ICF/MR, and other fee-for-service benefits to UNISYS instead of HMOs.
03Update claim submission procedures to verify beneficiary presents both State Eligibility ID and HMO ID before processing.
04Remove copayment requirements from Plan A claims (zero copay for all covered services).
05Train billing staff on covered services list and which services route to HMO vs. FFS (UNISYS).
06Add note to system that organ transplant inpatient hospital costs route to FFS, not HMO.
07Ensure staff understand 60-day annual limit on per-therapy rehabilitative services under HMO plan.
08Contact State for questions at 1-800-356-1561.
If missed: Failure to properly route and process claims will result in denials and payment delays.

Original notice

Newsletter Vol. 8, No. 07
njmmis.com · Always check the source before changing claims.
View original ↗

Related changes

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