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Click here To Report Fraud or Abuse In the Medicaid Program or Call 1-888-937-2835.     
New: Attention Providers using eMevs – The eMevs response screen now provides direct access to referenced newsletters in eligibility messages by clicking on the blue underlined hyperlink in the message text.
New:  Click here for the 2017 NJ Medicaid/HMO Encounters EDI Claims Submission Deadline Schedule.
New:  Click here for the 2017 Charity Care Claims Submission Schedule.
New: Effective immediately, Molina Medicaid Solutions will no longer offer Imprinted Forms. We will continue to supply all forms previously available, but will discontinue the imprinting directly on the form.
You can continue to request forms via the NJMMIS or through our Provider Services call center.
New: Attention Providers of Durable Medical Equipment and Medical Supplies (DME providers) – The NJ Medicaid Fraud Division will be hosting a training for DME providers on December 15, 2016. Click here for more information about the training goals and how to register for the training session.
New: Attention Providers-click here to obtain new guidelines regarding the Patient Volume Look Back Period for NJ’s EHR Provider Incentive Program.
New:  Click here to obtain information about the influenza vaccine and The NJ Vaccines for Children (VFC) Program.
Revised HMO Encounters Systems Guide dated January 2017 has been published and made available in the Forms & Documents link at the left of the page or it can be found under the HIPAA Companion Guides paragraph under the additional Headlines page or click here.
Revised Notice of Application Fee: The Patient Protection Affordable Care Act, better known as the Affordable Care Act (ACA), has implemented a $560 application fee (for calendar year 2017) to be paid by a list of defined new provider types applying to NJ Medicaid/NJ FamilyCare, for those applicable provider types that are required to be re-enrolled (revalidated) and for those providers who wish to have their files reactivated.This required fee will apply to the following applicants: ambulatory care clinics, ambulatory surgical centers, federally qualified health centers (FQHC), ESRD centers, independent laboratories, mental health clinics, Medicare-certified home care agencies (only), hospice agencies, hospitals, long-term care (LTC) facilities, medical suppliers, optical appliance providers, pharmacies, portable x-ray providers, prosthetic and orthotic (P&O) providers, rehabilitation providers, special hospitals, intermediate care facilities (ICF/MR), workfirst providers, and ambulance transportation providers. Please note: submitting proof (eg. copy of a cancelled check) that an application fee already was paid to Medicare or another state’s Medicaid agency when applying or re-enrolling will waive the required application fee.
Revised The NJ Medicaid MEVS/POS Switch Vendors List dated November 2016 has been published and made available in the Forms & Documents link at the left of the page or click here.
Revised The 5010 HIPAA Companion Guide dated October 2016 has been published and made available in the Forms & Documents link at the left of the page or it can be found under the HIPAA Companion Guides paragraph under the additional Headlines page or click here.
Attention Pharmacy Providers: DMAHS shall terminate the enrollment of any FFS pharmacy provider whose reenrollment application has not been received by August 15, 2016. The Patient Protection and Affordable Care Act (PPACA) of 2010, commonly called the Affordable Care Act (ACA), requires that all FFS providers be reenrolled. Any pharmacy needing assistance with reenrollment should contact Molina Medicaid Solutions Provider Services at 1-800-776-6334.
Providers can now check Eligibility in eMEVS by SBI (Unique State Prison Case Number). For further information on billing for services provided to incarcerated individuals, please refer to Medicaid Newsletters Vol. 24 Number 15 and Vol. 25 Number 4.
For LTC and Assisted Living Providers - Effective Friday, May 6, 2016, Nursing Facility and Assisted Living Facility providers will receive patient responsibility (PR) data as part of a eMEVS response on the NJMMIS website. The PR data is being provided as information only and represents the member’s net income. As this PR information doesn’t include consideration of a member’s maximum patient payment liability, providers are required to use only the PR1 or PR2 copy, which are received by mail from the State, as the official record of a member’s cost share.
Attention Medicaid Pharmacy Providers: Click here for an invitation to An Overview of Medicaid Fraud & Prevention training session on June 1, 2016.
Click here for a listing of 2016 procedure code additions and deletions. 
The Children’s System of Care (CSOC) is currently enrolling new agencies, medical/mental health practices, or individuals seeking to become enrolled by Medicaid as providers of Intensive In-Community (IIC) Mental Health Rehabilitative Services for children, youth and young adults. CSOC encourages those with particular specializations as well as out of home treatment providers to apply in order to strengthen our community based services. To seek additional information regarding the application process, please click here.
Attention Medicaid Home Health Providers: Click here for an invitation to An Overview of Medicaid Fraud & Prevention training session on February 4, 2016.
CMS announces new Facility Code Value/Place of Service Code for Outpatient Hospital to be effective January 2016 - The Centers for Medicare & Medicaid Services (CMS) has announced the addition of a new Place of Service (POS) code value of 19 - Off Campus-Outpatient Hospital and a revision to the descriptor for the current POS code value 22 - On Campus-Outpatient Hospital. The new/updated Place of Service Codes impact CMS-1500 Claims, Encounters and Medicare/Medicaid CMS-1500 Crossover Claims as well as Claims and Encounters submitted electronically in the 837 Professional EDI ASC X12N/005010X222A1 format. New Jersey Medicaid/Molina Medicaid Solutions will begin accepting the new Place of Service codes effective January 4, 2016.
Notice to Providers: Providers can no longer use a SSN containing all the same numbers on the eMevs Inquiry Screen. For example 999999999.
Enhanced Editing For Referring/Prescribing Physician Field on Home Health and Lab Claims - In an effort to be fully compliant with ACA requirements, the claims system was modified in September, 2014 to ensure that certain claims, including those from Labs and Home Health Agencies, include the prescriber’s NPI in the Referring/Prescribing Physician field.  Paper claims and claims submitted through Direct Data Entry require both the prescriber’s NPI and 7 digit NJ Medicaid provider number.  Claims that do not provide this information or provide invalid information in this field are not being approved for payment.
RA Enhanced NPI Editing In an effort to be fully compliant with ACA requirements, on or about July 7, 2014 the claims system is being modified to ensure that the reported NPI is registered with NJ Medicaid and that there is an existing relationship between all submitted NPI’s and NJ Medicaid provider numbers. If an existing relationship cannot be verified between the NPI and the NJ Medicaid provider number, claims will be denied. A Newsletter providing more detailed information regarding this requirement will be issued in the near future.
NOTICE TO PHARMACIES The Division Of Medical Assistance and Health Service will no longer send out the yearly Pharmacy Provider Certification Statement, the FD 70 (11/16/2012) to pharmacies. The form has been modified  and now called FD-70A (11/04/2013) and can only be found in the enrollment packet of a newly enrolling pharmacy provider.
Notice of New Program:
The Division of Developmental Disabilities (DDD) is in the development stages of a new program called the Supports Program, which will provide needed supports and services for adult individuals, 21 and older, living with their families or in their own unlicensed homes. With the exception of anyone enrolled on the Community Care Waiver (CCW), all adult individuals who are eligible for both DDD services and Medicaid will be able to access the Supports Program.  The Supports Program is one of several important reforms included in the State’s Comprehensive Medicaid Waiver (CMW), which was approved on October 1, 2012. It will offer participants the following services: Assistive Technology, Behavioral Management, Career Planning, Cognitive Rehabilitation Therapy, Community-Based Supports, Community Inclusion Services, Day Habilitation, Environmental Modifications, Fiscal Management Services, Goods & Services, Interpreter Services, Natural Supports Training, Occupational/Physical/Speech Therapies, Personal Emergency Response System, Prevocational Services, Respite, Support Coordination, Supported Employment – Individual, Supported Employment – Small Group, Supports Brokerage, Transportation, and Vehicle Modifications.
Providers wishing to participate in the program and become approved to deliver services should review services definitions and qualifications.  This information can be accessed through DDD’s Supports Program Provider Portal website. To download the application click here.
Attention Providers: If you are presently an enrolled active NJ Medicaid fee-for-service provider (billing/servicing provider), this notice does not require you do take any action however please read this important announcement as it may affect the payment of your claims. The Patient Protection and Affordable Care Act (PPACA) now requires that all healthcare professionals who are involved with the care of fee-for-service Medicaid recipients (also known as ‘straight Medicaid’) to enroll as either a ‘billing/servicing’ NJ Medicaid provider (authorized to bill Medicaid) or as “non-billing” NJ Medicaid provider (limited authority to referring, prescribing, attending, operating—cannot bill Medicaid). On January 1, 2013, any claim submitted by an enrolled Medicaid provider containing the NPI number of referring, ordering prescribing, attending or operating medical professional who is not enrolled as either a ‘billing’ or ‘non-billing’ provider will be denied. To download the abbreviated enrollment application (FD-20B 03/01/2013) to become a ‘non-billing’ provider please click here. As a ‘non-billing’ provider your name or business will not show up on any public Medicaid provider directory. You will NOT be required to see Medicaid patients. Only an enrolled Medicaid provider will have access to a ‘non-billing’ provider directory and only through the secured area of this website. If you wish to have an application faxed or mailed to you, call the Molina Medicaid Solutions Provider Enrollment Unit at 609-588-6036. Enrollment packets to become an enrolled ‘billing’ provider can be found on the “Provider Enrollment Application” link on home page on this website.   To print a notice regarding this information click here.
 The 270/271 HIPAA Companion Guide for MEVS Switch Vendors dated June 2016 has been published and made available in the Forms & Documents link at the left of the page or it can be found under the HIPAA Companion Guides paragraph under the additional Headlines page or click here.
The New Jersey NCPDP D.0/1.2 Payer Sheet dated August 2015 has been published and made available in the Forms & Documents link at the left of the page or it can be found under the HIPAA Companion Guides paragraph under the additional Headlines page or click here.
The NJ Medicaid HIPAA 5010 Approved Vendor List dated April 2015 has been published and made available under the "Approved Vendor List" tab at the left of the page or click here.
Enhancements to the NJMMIS website!!! The NJMMIS website now gives registered users the ability to create and manage sub-accounts! This feature will allow an administrator the ability to designate multiple users to the site. The website will also allow users to create an enhanced security question in order to reset their own password, rather than wait to receive the logon information in the mail. Watch the presentation here for a demonstration of these new features. 
 NCPDP D.0/1.2 EDI Agreements, dated October 2012, have been published and made available in the Forms & Documents link at the left of the page. Be sure to use the most current version of the forms as older versions will be rejected.
Notice to NJ Medicaid Providers WITHOUT an NPI Number:  The Patient Protection and Affordable Care Act, which was passed in March of 2010, requires that all healthcare professionals participating as a provider in any of the NJ Medicaid programs be identified by a National Provider Identifier (NPI) number. Healthcare professionals may request an NPI number by visiting the National Plan and Provider Enumeration System (NPPES) website or by calling 1-800-465-3203 for additional information. After being assigned an NPI number, providers are required to submit a signed written notice to Molina Medicaid Solutions using your letterhead. The notice must include your new NPI number and also your seven digit NJ Medicaid provider number. The letter can be mailed to Molina Provider Enrollment Unit, PO Box 4804, Trenton NJ 08650 or you may fax a copy to 609-584-1192. Failure to have an NPI number reported (the referring, prescribing or ordering professional also) as part of a healthcare claim to NJ Medicaid by January 1, 2013 will result in the denial of the claim.
Molina Medicaid Solutions is pleased to announce the implementation of a new claims feature that will now allow providers to complete and submit on-line adjustments to previously adjudicated claims. This enhancement will allow for expedited processing and correlates to our Go-Green initiatives. This feature is live for claims adjustments to CMS-1500, CMS-1500 Crossover Claims, Dental, Transportation and Transportation Crossover Claims. Providers can log on to the secure area of the website utilizing the assigned user name and password to access this option. As a good practice, providers should continue to print their confirmation page for each submitted adjustment. On-line adjustments are processed over the following weekend. Once they are listed on your weekly Remittance Advice, questions regarding on-line adjustments can be directed to Provider Services at 1-800-776-6334. Other claim types will be available for on-line adjustment at a later time and will be announced to the provider community.
The Care Management Workbook contains Care Management Framework, Definitions and Tools for performing Comprehensive Needs Assessments, developing Care Plans, and the Care Management Process for health plans and providers. This Workbook can now be accessed by clicking on the “Forms & Documents” option located on the left side of this websites homepage, or Click here
For providers who use eMEVS to verify beneficiary eligibility: eMEVS will now return the beginning eligibility date for a given eligibility segment, even if this date is before the begin date of the inquiry. Currently if a segment’s beginning date is before the inquiry begin date, the inquiry begin date is returned in the response. The end date will continue to not be beyond the end of the current month or the end date submitted in the inquiry. In addition, the following service type codes will be returned in the response. Previously, some of these were indicated in the returned messages. It should be noted that the return of these service types does not indicate a guarantee of payment for any claim that may be submitted. 1 – Medical Care 33 – Chiropractic 35 – Dental Care 45 – Hospice 47 – Hospital 86 – Emergency Services 88 – Pharmacy 98 – Professional (Physician) Visit – Office AL – Vision (Optometry) MH – Mental Health UC – Urgent Care
Announcement for Beneficiaries enrolled in Medicare and Medicaid Click here - download and post and Announcement for 2012 Open Enrollment for Beneficiaries Click here - download and post
SFY 2012 July 1st Pharmacy Budget Information Click here for Newsletter Volume 21 No. 14 Click here for Newsletter Volume 21 No. 15 
SFY 2012 July 1st Phamacy Budget Information - Beneficiary Poster/ Click here for Poster
In an effort to make the EDI Agreements easier to locate form IDs have been assigned and the titles have been changed. These are now available in the Forms & Documents link at the left of the page.
Important Message Regarding Paper Claims Submissions: To avoid claims processing delays, it is highly imperative that providers submitting hard copy claims assure that their paper claims are mailed to the appropriate Post Office Boxes. Information regarding the Molina Medicaid Solutions PO Boxes can be located in the NJ specific Billing Supplements, Training materials on our website at or you can contact Provider Services for the correct PO Box at 1-800-776-6334. Click here for a listing of our PO Boxes for your convenience.
Procedure Master Listing - Outpatient Hospital Services Only is a new link in 'Procedure Codes & Rates'.
DRG Description/Weights and Hospital Rate & CCR information is now available in Procedure Codes & Rates under DRG Pricing.
DRG Pricing information is now available under Procedure Codes & Rates. 
April 2008: A moratorium remains in effect for enrollment of the following provider types: chiropractors, podiatrists, mental health partial care and medical supplies (DME).  For additional information, please contact 609-588-6036.
Forms Used by Hospice Providers (1-10) are now available in Forms & Documents under 'Hospice Forms' in 'Choose A Topic'.
FQHC Change of Scope Information including Instructions and Forms are now available in Forms & Documents under the Topic of Administration.
Current Provider Rates for Adults are available through this site. Click here.
Click here for information on the new CMS 1500 form.
Claim Check News! Click here for announcements and latest information/messages.
Providers can electronically verify a beneficiary's eligibility by using eMEVS, which is accessible through the secure section of this NJMMIS website. A UserName and Password are required. If you don't have a UserName and Password, click on 'Provider Registration' to the left for instructions.