All PlansPrior AuthMedium impact
Newsletter Vol. 7, No. 66
New Jersey Medicaid·NJ · Psychiatry, Pediatrics, Family Medicine·Prior Authorization
We identified it
Jun 20, 2026
Summary
New prior authorization requirements have been implemented for behavior management procedure codes. This policy change affects billing practices that provide behavioral health services and requires updated authorization processes.
Action Required
Immediately: Billing team must review the full policy document at https://www.njmmis.com/documentDownload.aspx?document=7-66.pdf to identify specific behavior management codes requiring prior authorization. Update billing system to flag these codes for prior auth verification before claim submission. Train front desk staff to verify authorization status during scheduling for behavior management procedures.