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Newsletter Vol. 1, No. 05
Act
immediately
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
This policy clarifies billing form requirements for certified HealthStart providers in New Jersey, effective immediately. Pediatric HealthStart services must use the MC form (Report and Claim for EPSDT HealthStart Screening and Related Procedures), while maternity services must use the NJ Health Insurance Claim Form. The policy eliminates the need to submit form FD (Preventive Child Health Visit Record) when using the MC form, and all EPSDT/HealthStart claims must be submitted within 30 days of service.
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What to do
immediately · 7 steps
01Billing team must update claim submission procedures for all HealthStart providers in New Jersey.
02For Pediatric HealthStart services: Stop using any previous forms and require use of Report and Claim for EPSDT HealthStart Screening and Related Procedures (MC form) for all physician services, independent clinics, local health departments, and hospital outpatient departments.
03Discontinue submission of form FD (Preventive Child Health Visit Record) when MC form is used.
04For maternity services: Ensure all claims use Health Insurance Claim Form NJ for physician services, nurse midwifery services, independent clinics, and local health departments.
05Implement 30-day claim submission deadline in billing system for all EPSDT and HealthStart services—claims submitted after 30 days from date of service will be denied.
06Contact Unisys for EMC specifications and Fiscal Agent Billing Supplement guidance.
07Update provider education materials and billing templates.
If missed: Failure to use correct forms and meet deadlines will result in claim denials.
Original notice
Newsletter Vol. 1, No. 05
njmmis.com · Always check the source before changing claims.
Related changes
See all New Jersey Medicaid changes →Newsletter Vol. 1, No. 02MediumNo effective date · PharmacyNewsletter Vol. 1, No. 03HighEffective Nov 1, 1993 · Provider NoticeNewsletter Vol. 1, No. 1LowNo effective date · Provider NoticeNewsletter Vol. 1, No. 04MediumNo effective date · Provider NoticeBrowse every New Jersey Medicaid change in the policy list