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New Click here To Report Fraud or Abuse In the Medicaid Program. 
New Discontinuation of Bulletin Board System (BBS) Effective November 1, 2014 the Bulletin Board System (BBS) will no longer be available for the submission of claims, instead all electronic claims must be submitted to Molina Medicaid Solutions via the NJMMIS website (www.njmmis.com). Should you need further technical assistance or if you would like to speak with a representative, please contact the Molina EDI Unit at 609-588-6051.
New Enhanced Editing For Referring/Prescribing Physician Field on Home Health and Lab Claims - In an effort to be fully compliant with ACA requirements, on or about September 1, 2014 the claims system is being modified 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 will 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 will not be approved for payment.
New – Effective July 1, 2014 a transition of coverage responsibilities for certain NJ FamilyCare long-term services and supports (including certain residential long-term care services, and the ACCAP, CRPD, TBI and GO Waivers) transitioned from the Fee For Service (FFS) program to the Managed Long-Term Services and Supports (MLTSS) program. Detailed information on MLTSS is provided in Newsletter Volume 24, No. 07 dated July 2014 Click Here.  Because enrollment into a Managed Care Organization (MCO) is mandated, members who are not currently enrolled in a Medicaid MCO are being auto assigned for enrollment into MLTSS effective August 1 or September 1.  However, during the auto assignment process, the members may be at risk for waiver services.  Providers are urged to continue the provision of waiver services during the transitional months of July and August and to bill Medicaid if the member is Medicaid eligible but not yet enrolled in an MCO.  While these waiver claims submitted and processed for July and August will deny, the State will honor them by conducting a one-time reprocessing for payment sometime after August.  In addition, in support of the MLTSS implementation, the Division of Medical Assistance and Health Services is offering MLTSS Provider Education Sessions throughout the State beginning Thursday July 10, 2014  through July 21, 2014 – Click Here to see Medicaid Alert MA-2014-01 dated July, 2014 to obtain complete schedule for the Education Sessions and instructions on how to register for one of these sessions.
New 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.
Revised Re-enrollment to Begin Soon: A new requirement of the Affordable Care Act (ACA) is that the Division of Medical Assistance and Health Services complete a re-enrollment of all Medicaid providers every five years. As a result of this new federal regulation, the Division has until March 2016 to become compliant. On or about June 2014, the Division will begin the re-enrollment of all providers who have enrolled prior to January 1, 2013. Any provider enrolled on or after January 1, 2013 or who submitted a completed enrollment packet for reactivation on or after January 1, 2013 will not be requested to re-enroll. The re-enrollment process will be done in monthly stages with notices going out to the providers to be enrolled 30 days in advance. ACA has also imposed a required $542 (for calendar year 2014) re-enrollment application fee for the following provider types: 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 that if a provider has already paid a fee to Medicare or another state’s Medicaid agency they will not be required to pay it again providing they can provide proof of payment (eg. Copy of a cancelled check).  Additional information will be announced as it is available.
Revised Notice of Application Fee:  The Patient Protection Affordable Care Act, better known as the Affordable Care Act (ACA), has implemented a $542 application fee (for calendar year 2014) 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.
Click here for the 2014 Charity Care Claims Submission Schedule.
Click here for the 2014 NJMMIS EDI Claims Submission Deadline Schedule.
New Testing for the new CPT psych codes should be completed 8/5/13. Claims for these codes that are submitted between 8/1/13 and 8/5/13 will receive a pended message. The pended claims will be systemically recycled every 7 days. For any claims submitted after 8/5/13, we anticipate that they will be fully adjudicated during the processing cycle without the need to pend.
New 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.
Revised Notice of Physicians Rate Increase: Physicians with a specialty or subspecialty designation of family medicine, general internal medicine or pediatrics are qualified to receive the enhanced reimbursement rates for CPT procedure codes 99201 through 99499 and 90460 through 90474, if a physician submits a properly completed Affordable Care Act (ACA) Self-Attestation Form (click here). The Attestation Form requires a qualified physician to self-attest to an eligible specialty or subspecialty; AND either attest to the fact that his or her Board certification is current as of January 1, 2013 or later; or attest to a claims history in which sixty (60) percent of a qualified physician’s FFS and/or NJFC/Medicaid HMO claims volume in CY 2012 was for CPT procedure codes 99201 through 99499 and 90460 through 90474.  If a physician bills CPT procedure code 90461 to a NJFC/Medicaid managed care plan for the administration of vaccines, the number of claims for these services may count towards the 60 percent claim threshold for additional information please go to Newsletter Volume 23, No. 04 issued in January 2013.
Attestations can be submitted any time as of January 1, 2013 up to January 1, 2015.  Physicians who submit a Self-Attestation Form that is received by Molina Medicaid Solutions prior to June 1, 2013 will be eligible to receive enhanced payments for claims with service dates on or after January 1, 2013.  Physicians that submit a Self-Attestation Form received by Molina Medicaid Solutions on or after June 1, 2013 will be eligible to receive enhanced payments for claims with service dates on or after the first of the month in which the self-attestation was received.
For physicians in a group practice who supervise an Advanced Practice Nurse and submit a Self-Attestation Form received by Molina Medicaid Solutions prior to September 1, 2013, their group practice will be eligible to receive enhanced payments for claims with service dates on or after January 1, 2013.  For physicians in a group practice that submit a Self-Attestation Form received by Molina Medicaid Solutions on or after September 1, 2013, their group practice will be eligible to receive enhanced payments for claims with service dates on or after the first of the month in which the self-attestation was received.
New Jersey will be increasing Medicaid primary care rates as quickly as possible, once final approval has been received from the U.S. Centers for Medicare and Medicaid Services.  Once final approval has been received, the State will retroactively adjust provider payments.  To further ensure that these adjustments are paid correctly, providers are reminded of the importance of reporting their true usual and customary charges on these claims.
New Attention Providers: The NJMMIS website now gives registered users the ability to associate the User Names with their Sub-Accounts! This feature will allow an Administrator the ability to designate the First Name, Middle Initial and Last Name to existing as well as to new Sub-Account users accessing the website.
New 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.
Revised - A revised HMO Systems Guide dated October 2014 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 - A 5010 HIPAA Companion Guide dated October 2014 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 – The New Jersey NCPDP D.0/1.2 Payer Sheet dated October 2014 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 A revised NJ Medicaid HIPAA 5010 Approved Vendor List dated July 2013 has been published and made available under the "Approved Vendor List" tab at the left of the page or click here.
Revised - A 270/271 HIPAA Companion Guide for MEVS Switch Vendors dated April 2013 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 - A revised NJ Medicaid MEVS/POS Switch Vendors List dated October 2014 has been published and made available in the Forms & Documents link at the left of the page or click here.
New Click here for the 2013 Charity Care Claims Submission Schedule.
New Click here for the 2013 NJMMIS EDI Claims Submission Deadline Schedule.
All users of eMEVS who verify beneficiary eligibility:
Towards the middle of December 2012, eMEVS will begin to return two additional service type codes provided the beneficiary is in fact eligible for them - 48 – Inpatient Hospital  and 50 – Outpatient Hospital.  It should be noted that the return of these, or any others currently returned, does not indicate a guarantee of payment for any claims that may be submitted. 
Revised5010 EDI Agreements EDI-101, EDI-201, EDI-301 and EDI-801, 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.
New 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. Stay tuned for further enhancements to NJMMIS.com as we continue to update the site with even more features that will allow you to better manage your website experience.
RevisedNCPDP 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.
New 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 https://nppes.cms.hhs.gov 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.
Attention EDI Submitters:The HIPAA Companion Guides & NCPDP Payer Sheet will now be revised and published on a quarterly basis.  The schedule for replacement versions (if updates are required) is January, April, July and October. Any updates that become necessary between these times will be published in an associated Technical Update on an as-needed basis.  The associated Technical Update is to be used in conjunction with the last published Companion Guide or Payer Sheet until the next replacement Companion Guide or Payer Sheet is published.  An announcement will be placed on the Announcements page of the website noting publications of revised guides.  The Technical Updates will contain all updates (and effective dates of those updates) to be made to the Companion Guide or Payer Sheet up until the quarterly publication on the website.  At that time, all previous updates incorporated in the associated Technical Update will be refreshed.
                            Quarterly Published       
   HIPAA Companion Guides & NCPDP Payer Sheet
  • 270/271 HIPAA Companion Guide (Version 5010)
  • 837/835/277P HIPAA Companion Guide (Version 5010)
  • HMO Encounters Systems Guide (Version 5010)
  • NCPDP D.0/1.2 Payer Sheet

                            As Needed Published       
                 Associated Technical Update
  • 270/271 Technical Update
  • 837/835/277P Technical Update
  • HMO Encounters Technical Update
  • NCPDP D.0/1.2 Technical Update

The associated Technical Updates will be located in the Forms & Documents link and under the HIPAA Companion Guides paragraph under the additional Headlines page with their associated Companion Guide & NCPDP Payer Sheet.
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
Revised 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.
Direct Data Entry Now Available. New Jersey Medicaid claims that meet the submission criteria can now be submitted directly via the NJMMIS Website reducing paper and saving processing time. Please click here for more information.
Revised – A revised HIPAA Attachment Cover Sheet is now available in the Forms & Document area of the website. The revised form now allows a range of ICN control numbers to be entered for claims containing consecutive lines.
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 NJMMIS.com 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. 
ATTENTION ALL EDI SUBMITTERS: HIPAA Claims Rejected reports are now available for downloading from the HIPAA Claims link for EDI Submitters. Click here for details and here for a presentation.
Revised - A revised HIPAA Attachment Cover Sheet is now available in the Forms & Document area of the website. The revised form now includes the attachment code of "01". Third Party Liability (TPL) /  Explanation of Benefits (EOB) or Denial Letter other than Medicare allowing for the electronic submission of claim(s) containing TPL and enabling the submission of EOB documentation to follow.
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 to access and search for New Jersey health care professional information (including physician's medical license number).
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.