MedicaidPrior AuthMedium impact
Newsletter Vol. 4, No. 15
New Jersey Medicaid·NJ·Prior Authorization
We identified it
Jun 20, 2026
Summary
New prior authorization requirements have been implemented for billing more than 16 hours of private duty nursing services within a 24-hour period under Model Waiver III and ACCAP programs. This affects Medicaid waiver services requiring additional approval processes for extended nursing care.
Action Required
Immediately: Billing team must implement prior authorization verification for all private duty nursing services exceeding 16 hours within a 24-hour period under Model Waiver III and ACCAP. Update billing system to flag these cases and ensure authorization is obtained before service delivery. Claims submitted without proper authorization will be denied.