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Click here To Report Fraud or Abuse In the Medicaid Program or Call 1-888-937-2835.     
NEW! Medicaid Providers: Talk to your patients about important updates to their NJ FamilyCare/Medicaid coverage. Patients must renew their Medicaid eligibility annually to continue their coverage. Tell patients to respond to their NJ FamilyCare renewal packet mailing, even if it's overdue. Go to StayCovered NJ to learn more.
Click here for the 2024 NJ Medicaid/HMO Encounters EDI Claims Submission Deadline Schedule.
Click here for the 2024 Charity Care Claims Submission Schedule.
Revised: A revised 837/835/277P HIPAA Companion Guide dated April 2024 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 additional Headlines page or click here.
Revised: A revised HMO Encounters Systems Guide dated December 2023 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 New Jersey NCPDP D.0/1.2 Payer Sheet dated November 2023 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.
New: Please click here for a new application for Groups to apply as a NJ Medicaid Provider under 21st Century guidelines. Please note, this application is for the sole purpose of enrolling with Medicaid in order to contract with MCOs, this will not allow a provider to bill directly for FFS.  Please direct any questions to the Gainwell Provider Enrollment Contact Center at 609-588-6036.
New: HIPAA 5010 276/277 Inquiry Transaction Set: To notify Medicaid/New Jersey FamilyCare (NJFC) Fee-For-Service (FFS) providers and NJ Charity Care Providers of future changes to the New Jersey Medicaid Management Information System (NJMMIS) to accept the HIPAA 5010 276/277 Claim Inquiry Transaction Set permitting providers to inquire regarding the status of previously submitted healthcare claims.  Gainwell Technologies LLC will be working with submitters who will outreach certain providers to participate in system testing for the HIPAA 5010 276/277 Inquiry Transaction Set. Providers should visit this Announcement Page on or after October 28, 2023, to confirm that the HIPAA 5010 276/277 Inquiry Transaction Set is in production. Providers should also outreach their submitter with any for questions related to submitting and receiving HIPAA 5010 276/277 inquiry/response transactions. The HIPAA 5010 276/277 Inquiry Transaction Set companion guide can be found under the HIPAA Companion Guides paragraph under additional Headlines page or click here.
New: The Special Program Codes (SPCs) can now be accessed by clicking on the “Forms & Documents” option located on the left side of the homepage or click here.
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.
Revised: Notice of Application Fee: The Patient Protection Affordable Care Act, better known as the Affordable Care Act (ACA), has implemented a $688.00 application fee (for calendar year (CY) 2023) 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/IID), 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: A revised 270/271 HIPAA Companion Guide for MEVS Switch Vendors dated December 2022 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.
Notice for EDI Submitters: Please be informed of a routine upgrade of EDI translate software between October 1 - October 8, 2022 at Gainwell Technologies. This upgrade should be transparent without any noticeable differences to the Submitter community. Please contact the EDI Unit at 609-588-6051 between the hours of 8-5 Monday through Friday or send email to NJMMISEDI@gainwelltechnologies.com if EDI issues are encountered.
ATTENTION Providers of Applied Behavior Analysis (ABA) services (BCBA-Ds, BCBAs, BCaBAs, RBTs and related agencies): Gainwell Technologies will begin reimbursing NJFC Medicaid enrolled ABA agency providers for Autism Spectrum Disorder (ASD) treatment services, including behavior identification assessments, supporting assessments, adaptive behavior treatment, individual and group, and family adaptive behavior treatment, billed with service dates on or after April 1, 2020. ASD is a collection of neurodevelopmental disorders characterized by communication challenges, repetitive behaviors and limited social skills. These services are available to any NJFC Medicaid child, under the age of 21, who has been diagnosed with ASD defined by ICD-10-CM diagnosis codes F84.0 through F84.9. Provider agencies currently enrolled in NJFC Medicaid who wish to participate in the ABA program must complete and submit the ASD Treatment Provider Addendum. Provider agencies not currently enrolled in NJFC Medicaid must complete the ASD Treatment Provider Application for all provider types. Please click the link (here) to download a copy of the Addendum or click the link (here) to download the Provider Application. The Addendum and required credentials must be mailed to Gainwell Provider Enrollment, P.O. Box 4804, Trenton, NJ 08650. Inquiries related to completion of the Addendum may be directed to Gainwell Provider Enrollment at 609-588-6036. For more specific program inquiries, providers should contact the DMAHS Office of Customer Service at 609-631-4642 as indicated in the Newsletter.
Revised: ATTENTION Office Based Addiction Treatment Providers (OBAT): Gainwell Technologies will begin reimbursing NJFC Medicaid enrolled OBAT providers for OBAT-related services, including the initial intake, evaluation, and navigator services, billed with service dates on or after January 1, 2019. The OBAT program is designed to enhance access and improve utilization of non-methadone MAT services for NJFC Medicaid beneficiaries. Please refer to the Medicaid Newsletter Volume 29, No. 18, dated November 2019 for full details on the program including provider enrollment requirements. Providers who wish to participate in the OBAT program must complete and submit the OBAT Navigator Provider Addendum, meet all enrollment requirements, and obtain Gainwell approval before rendering OBAT services. Please click the link (here) to download a copy of the Addendum. The Addendum and required credentials must be mailed to Gainwell Provider Enrollment, P.O. Box 4804, Trenton, NJ 08650. Inquiries related to completion of the Addendum may be directed to Gainwell Provider Enrollment at 609-588-6036. For more specific program inquiries, providers should contact the DMAHS Office of Customer Service at 609-631-4642 as indicated in the Newsletter.
New: New Jersey Medicaid is no longer accepting attestations for the CY 2021 Medicaid Promoting Interoperability Program. The final deadline to submit an attestation for the incentive payment was October 15, 2021. According to federal regulations, New Jersey Medicaid must make all final incentive payments by December 31, 2021. To the eligible professionals who participated in CY 2021 attestations, please ensure that any necessary resubmissions are completed by December 18, 2021 - 8:00pm ET. This is to accommodate the two-week processing and disbursement of the incentive payments by Dec 31st.
Medicaid/NJ FamilyCare is pleased to announce that the on-line provider directory is available to the public through 3rd party mobile apps that connect to MyNJFCHealthData. The public directory includes the name, address, phone number, and specialty of actively participating providers in the Medicaid/NJ FamilyCare Fee-for-Service program. Please share this information with your patients. For additional information please visit the "Hot Topics" section of the DMAHS website here: https://www.nj.gov/humanservices/dmahs/home/index.html.
New Jersey Medicaid Promoting Interoperability Program Attestation Deadline for Eligible Professionals for Calendar Year 2021 - 2021 is the last year eligible professionals can attest to and receive an incentive payment. Federal regulations require that all final incentive payments are made by December 31, 2021. The State have designated October 15, 2021, at 11:59PM as the attestation deadline, this date will allow sufficient time for the State, and as necessary the contracted audit vendors, to review the attestations and process payments within the specified Federal timeline. For additional information regarding the program, please click here.
Revised: The NJ Medicaid HIPAA 5010 Approved Vendor List dated April 2021 has been published and made available under the "Approved Vendor List" tab at the left of the page or click here.
Attention Providers using eMEVS – eMEVS now allows eligibility verification for one future month(one month beyond the current calendar month). Eligibility for claim payment for the future month is NOT guaranteed. Providers are advised to perform the eligibility verification again during the service month.
Guidance is available now for providers submitting claims for COVID-19 testing for NJ FamilyCare/Medicaid members at https://nj.gov/humanservices/coronavirus.shtml.  These services will be reimbursed at 100% of Medicare rates.  Please see Newsletter section for billing details.
ATTENTION Independent Clinic Providers: Gainwell Technologies will begin reimbursing Independent Clinics-Drug/Alcohol for substance use disorder (SUD) related peer recovery support services billed with service dates on or after January 1, 2019. Peer Recovery Support Specialists are individuals with lived experience who can support a person with SUD on their path to recovery. Peer Specialists are responsible for assisting beneficiaries with keeping appointments and connecting with community programs that may assist individuals establishing and maintaining recovery. Please refer to the Medicaid Newsletter Volume 29, No. 18, dated November 2019 for full details on the program including provider enrollment requirements. Independent clinics who wish to provide peer recovery support services must complete and submit the Peer Recovery Support Specialist Addendum, meet all enrollment requirements, and obtain Gainwell approval before rendering services. Please click the link (here) to download a copy of the Addendum. The Addendum and required credentials must be mailed to Gainwell Provider Enrollment, P.O. Box 4804, Trenton, NJ 08650. Inquiries related to completion of the Addendum may be directed to Gainwell Provider Enrollment at 609-588-6036. For more specific program inquiries, providers should contact the DMAHS Office of Customer Service at 609-631-4642 as indicated in the Newsletter.
Plan First is New Jersey's new Family Planning program open to enrollment on or after October 1, 2019.  Plan First is a NJ FamilyCare Medicaid fee-for-service program providing comprehensive family planning services and certain family planning-related services for both women and men.  
The State of New Jersey was pleased to present a series of Plan First provider training sessions for NJ FamilyCare Medicaid providers. Click here for the Plan First provider training slide deck. 
Revised: The NJ Medicaid MEVS/POS Switch Vendors List dated November 2020 has been published and made available in the Forms & Documents link at the left of the page or click here.
Effective 08/05/19, family planning providers must request payment from other insurers, including Medicare if a Medicare-covered service, prior to submitting family planning claims to the Medicaid/NJFC program.  Family planning providers are encouraged to review the Medicaid/NJFC policy regarding other insurance found at N.J.A.C. 10:49-7.3 and/or go to https://www.nj.gov/comptroller/resources/.  Providers may access REVS, eMEVS or MEVS to determine if other insurance is on file with the State.  To report changes in a beneficiary’s insurance coverage, contact the Third Party Liability Unit, Office of the State Comptroller, at 609-777-2753 or 609-826-4702.
Effective 08/05/19, providers who inappropriately reported a value of “Y” in the Family Planning (FP) Field (SV112) on professional claims or in the Condition Code Field (H101-2) on institutional claims for a non-FP service bypassed the opportunity for other insurance coverage.    When other insurance is on file with the State, claim payments shall deny without proof of payment by other insurance or a denial of other insurance payment reported with the claim.  Providers may access REVS, eMEVS or MEVS to determine if other insurance is on file with the State.  To report changes in a beneficiary’s insurance coverage, contact the Third Party Liability Unit, Office of the State Comptroller, at 609-777-2753 or 609-826-4702.
Attention ALL Providers and Submitters: Effective April 2019, the following new procedures will apply when providers or submitters request login credentials from Gainwell Technologies.
  • The “Provider/Submitter Forgot Password Letter” mailed by Gainwell Technologies will only report a provider’s/submitter’s new password. A provider’s/submitter’s username will no longer be reported along with the password in these letters.
  • The “Provider/Submitter Forgot Password Letter” will only be valid for a period of thirty (30) calendar days. After this period expires, a provider or submitter must re-apply to request a new password.
  • The “New Provider Registration Letter” will be sent by certified mail separately from letters announcing a provider’s user ID and password.
  • The “New Submitter Registration Letter” will be sent by certified mail separately from letters announcing a submitter’s user ID and password.
  • Requests to “Register UserID and Password” by terminated or cancelled providers/submitters will be declined by Gainwell Technologies.
  • Users will be prompted to enter a new email address when no email address is on file with Gainwell Technologies before being allowed to access the NJMMIS.
New Jersey Medicaid Promoting Interoperability Program (PIP) Attestation "REVISED" Deadline for Eligible Hospitals and Eligible Professionals for Calendar Year 2018. The deadline to attest for CY 2018 in the New Jersey Medicaid Promoting Interoperability Program for Eligible Hospitals and Eligible Professionals is April 1, 2019. All the participants for the New Jersey Medicaid Promoting Interoperability Program will have until 11:59 pm ET on April 1, 2019 to submit their CY 2018 attestations. Past this date, starting April 2, 2019, the provider incentive payment system will begin to accept the attestations for CY 2019.
Revised: 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 Program (CCP), 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: Providers can 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.
Effective July 1, 2018, the moratorium  in effect for the enrollment of chiropractors, podiatrists, mental health partial care and medical suppliers (DME) has been lifted. Providers choosing to enroll in the NJ FamilyCare Fee-For-Service program on or after July 1, 2018 as providers of chiropractic, podiatric, mental health partial care or medical supply services may submit a provider application for enrollment consideration.” Interested providers  may download an application at www.njmmis.com. 
Effective January 1, 2018, the 21st Century Cures Act (see 42 U.S.C.1396u-2(d)) requires that all network providers associated with managed care organizations (MCOs) participating in the Medicaid/NJFC program enroll with the State Medicaid Program or risk being removed from a MCO provider network.21st Century Cures Act providers are not eligible to receive Fee-For-Service (FFS) payments; however, they can be identified on a billed FFS claim as a referring, ordering, prescribing or attending (ROPA) provider if a Medicaid Provider ID Number has been assigned. Your participation will not be included in the Medicaid/NJFC FFS Provider Directory. Providers participating in multiple MCO provider networks only need to complete the 21st Century Cures Act application one time. MCO providers enrolled in the Medicaid/NJFC-FFS program are not required to complete a 21st Century Cures Act application if they have received an acknowledgement letter confirming their FFS enrollment either as a full provider or as a referring, ordering, prescribing or attending provider. To download a 21st Century Cures Act Application, click here. 
Attention Nursing Facilities and Assisted Living Facilities - Effective  August 15th  2017, the following changes will be implemented to eMEVS:
PR1 ‘available income’ will continue to be displayed. 
PR2 ‘available income’ will no longer be displayed.
A new section “Cost Share Data:”  will contain a PR1/PR2 Indicator and the corresponding cost share amount for the months that the Recipient was enrolled in MLTSS. 
Effective immediately, Gainwell Technologies 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.
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.
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.
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.
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 Gainwell Technologies 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.
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 11/04/2020) 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 Gainwell Technologies 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.
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 Gainwell Technologies 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 Gainwell Technologies 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.
Gainwell Technologies 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.
Effective 01/01/2008 there is a new Part D PDP servicing New Jersey, Fox Insurance Company. The code for NCPDP Other Payer Id field 340-7C is DFX. 
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
Forms Used by Hospice Providers (1-10) are now available in Forms & Documents under 'Hospice Forms' in 'Choose A Topic'.
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 Gainwell Technologies 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.
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.