MedicaidPrior AuthHigh impact
Newsletter Vol. 4, No. 53
New Jersey Medicaid·NJ·Coding
We identified it
Jun 20, 2026
Summary
New billing procedures for Garden State Health Plan (GSHP) Medicaid HMO recipients require a 10-digit Prior Authorization Number in the Remarks field and PCM provider information in Fields 6 and A of NJ claim forms. Claims missing this information will be denied.
Action Required
Immediately: Billing team must update claim submission procedures for GSHP Medicaid recipients. Always include the 10-digit Prior Authorization Number from PA forms in the Remarks field of NJ Medicaid claim forms. Enter PCM name and Medicaid Provider Number in Fields 6 and A respectively. Never attach PA forms to claims. For exempt services (DME, medical supplies, anesthesia, independent lab services ordered by PCM), still include PCM information in Fields 6 and A. Claims will be denied without proper PA numbers and PCM information.