MedicaidPrior AuthHigh impact
Newsletter Vol. 7, No. 43
New Jersey Medicaid·NJ·Coding
Effective date
Jul 1, 1997
We identified it
Jun 20, 2026
Summary
Multiple PCA providers serving the same Medicaid beneficiary must now obtain prior authorization when their combined hours exceed 25 per week, even if each individual provider works less than 25 hours. Claims must be submitted on paper HCFA 1500 forms to a special address, not electronically.
Action Required
Immediately: Home health agencies and homemaker agencies providing PCA services must coordinate with other providers to track total weekly hours per beneficiary. When multiple providers' combined hours exceed 25 per week, submit Prior Authorization Request Form (FD365) and PCA Socio-Medical Evaluation Form to the local Medicaid District Office. Use the PA number in box 23 of HCFA 1500 forms and mail hard copy claims to Bureau of Home and Community Services, P.O. Box 712, Mail Code #35, Trenton, New Jersey 08625-0712. Electronic submission is not allowed for these claims.