MedicaidPrior AuthHigh impact
Newsletter Vol. 4, No. 52
New Jersey Medicaid·NJ·Coding
We identified it
Jun 20, 2026
Summary
Garden State Health Plan (GSHP) is expanding their Medicaid HMO program, requiring providers to obtain prior authorization from the Primary Care Manager (PCM) before rendering services to GSHP recipients. Claims must include the PA number and PCM's Medicaid Provider Number or they will be denied.
Action Required
Immediately: Billing team must update UB claim form procedures to require PA number in Form Locator field and PCM's Medicaid Provider Number in referring physician field for all GSHP recipients. Train staff to identify GSHP recipients by restrictive messages on MEI cards or Gold Card presentation. Claims will be denied without both required elements.