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New Jersey MedicaidMedicaid · Administrative · Provider Notice · NJHigh impact

Newsletter Vol. 7, No. 04

Act
by Jan 31, 1997
Effective date
Feb 1, 1997
Identified
Jun 20, 2026

Summary

Effective February 1, 1997, Garden State Health Plan (GSHP) operations in Bergen, Middlesex, and Monmouth Counties, NJ are being sold to Managed HealthCare Systems (MHS). All GSHP enrollees in these three counties will transfer to MHS; claims submitted after February 1, 1997 for former GSHP members in these counties will be denied unless they involve ongoing hospitalizations from before the transition date.

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What to do

by Jan 31, 1997 · 5 steps
01Billing team must immediately stop processing claims for GSHP enrollees in Bergen, Middlesex, and Monmouth Counties with service dates on or after February 1, 1997.
02Update billing system to redirect these claims to Managed HealthCare Systems (MHS) at 1-888-362-3368.
03For any GSHP patients currently hospitalized as of February 1, 1997, continue GSHP billing for inpatient and associated physician services until separate instructions are provided.
04All staff must verify member HMO enrollment status via Medicaid eligibility card or online eligibility systems before processing claims.
05Billing staff should expect continued GSHP claims from the remaining 10 NJ counties (Atlantic, Burlington, Cumberland, Gloucester, Mercer, Morris, Salem, Somerset, Sussex, Warren) using existing GSHP instructions.
If missed: Failure to redirect claims will result in denials and payment delays.

Original notice

Newsletter Vol. 7, No. 04
njmmis.com · Always check the source before changing claims.
View original ↗

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