All PlansAdministrativeMedium impact
Newsletter Vol. 7, No. 63
New Jersey Medicaid·NJ·Provider Notice
We identified it
Jun 20, 2026
Summary
A new High Cost Case Management/Review Initiative has been implemented that will likely require additional review processes for expensive medical cases. This may affect billing workflows for high-cost procedures and treatments by adding review requirements or case management steps.
Action Required
Immediately: Review the full policy document at https://www.njmmis.com/documentDownload.aspx?document=7-63.pdf to understand specific case management requirements. Billing team should identify which high-cost cases will trigger review processes and update workflows accordingly. Coordinate with case management staff to ensure proper documentation and review procedures are followed.