New Jersey Medicaid — NJ FamilyCare (New Jersey Medicaid)
| Program name | NJ FamilyCare (New Jersey Medicaid) |
|---|---|
| Provider portal | https://njmmis.com |
| FFS claims payer ID | No single canonical ID — routing is fiscal-intermediary-specific. Verify per clearinghouse. |
| Medicaid timely filing | 180 days from date of service |
The federal ceiling for Medicaid timely filing is 12 months under 42 CFR §447.45; most states set a shorter window. Always verify the current policy on the New Jersey Medicaid provider portal before filing a late-billing appeal.
BCBS licensee in New Jersey
The Blue Cross Blue Shield Association licensee in New Jersey is Horizon Blue Cross Blue Shield of New Jersey. See the Horizon BCBS NJ payer guide for payer ID, timely filing, prior auth, and appeal procedures.
Top commercial payers in New Jersey
The dominant commercial insurers operating in New Jersey, in approximate order of lives covered. Click through for per-payer claims payer IDs, timely filing windows, prior-authorization rules, and appeal procedures.
Medicaid MCOs in New Jersey
NJ FamilyCare (New Jersey Medicaid) contracts with the following managed-care organizations to administer Medicaid benefits in New Jersey. MCO contracts dictate claims routing, prior-auth workflows, and appeal deadlines — route each claim by the member's MCO assignment, not the state FFS payer ID.
Medicare contractor and active LCDs in New Jersey
Novitas Solutions, Inc. is the Medicare A/B MAC for New Jersey: Part A and Part B fee-for-service claims from New Jersey go to it, and its Local Coverage Determinations decide local medical necessity. Durable medical equipment and supply claims go to Noridian Healthcare Solutions, LLC as the DME MAC. Home health and hospice claims are processed by Wellpoint Federal. In the current Medicare Coverage Database export, 129 active LCDs from these contractors apply to New Jersey claims.
- Novitas Solutions, Inc.
A/B MAC (Part A and Part B claims)
- Noridian Healthcare Solutions, LLC
DME MAC (durable medical equipment and supplies)
- Wellpoint Federal
Home health and hospice MAC
Selected active Novitas Solutions, Inc. policies for New Jersey
A selection, not the full list: policies with measured search demand come first, then those on topics that more contractors publish LCDs for.
- L35041 Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds
- L34892 Facet Joint Interventions for Pain Management
- L36920 Epidural Steroid Injections for Pain Management
- L39365 Genetic Testing in Oncology: Specific Tests
- L34914 Assays for Vitamins and Metabolic Function
- L35396 Biomarkers for Oncology
- L35010 Trigger Point Injections
- L35038 Scanning Computerized Ophthalmic Diagnostic Imaging
- L34938 Removal of Benign Skin Lesions
- L35138 Routine Foot Care
- L38916 Respiratory Pathogen Panel Testing
- L35006 Controlled Substance Monitoring and Drugs of Abuse Testing
Equipment, home health and hospice policies that apply in New Jersey
- L33822 Glucose Monitors
- L33789 Power Mobility Devices
- L33318 Knee Orthoses
- L33686 Ankle-Foot/Knee-Ankle-Foot Orthosis
- L33718 Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea
- L33792 Wheelchair Options/Accessories
- L33797 Oxygen and Oxygen Equipment
- L33393 Hospice - Determining Terminal Status
Steps to confirm which LCD governs a claim · Every active LCD by contractor
State-specific regulations affecting New Jersey billing
- NJSA 26:2SS-1 et seq. (Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act, 2018)
- NJAC 11:22-1 (prompt payment of health benefits claims — 30 days electronic clean claim)
- NJ A-4676 (hospital charity care / medical debt reform)
Provider licensing & enrollment in New Jersey
Providers enroll via NJMMIS Provider Web Portal (Molina MMIS / Gainwell). NJ FamilyCare MCOs contract separately; CAQH ProView accepted.
Major health systems headquartered in New Jersey
| Health system | Headquarters |
|---|---|
| RWJBarnabas Health | West Orange, NJ |
| Hackensack Meridian Health | Edison, NJ |
| Atlantic Health System | Morristown, NJ |
| Virtua Health | Marlton, NJ |
| Cooper University Health Care | Camden, NJ |
Frequently asked questions — New Jersey billing
What is the New Jersey Medicaid program called?
New Jersey's Medicaid program is known as NJ FamilyCare (New Jersey Medicaid). Providers enroll and manage claims through the provider portal at https://njmmis.com.
What is the New Jersey Medicaid timely filing limit?
NJ FamilyCare (New Jersey Medicaid) requires initial claims to be filed within 180 days from the date of service. The federal ceiling is 12 months under 42 CFR §447.45; New Jersey's 180-day window is set by the state provider manual. Late-billing exceptions may be allowed with good-cause documentation — verify on the state portal before filing an appeal.
Does New Jersey Medicaid publish a single claims payer ID?
No single canonical claims payer ID is published for NJ FamilyCare (New Jersey Medicaid). Claims route through the state's fiscal intermediary; look up the correct submitter ID in your clearinghouse directory (Availity, Change Healthcare/Optum, Waystar) and route managed-care claims by the member's MCO assignment.
Who are the largest commercial insurers in New Jersey?
The dominant commercial payers in New Jersey include Horizon BCBS NJ, Aetna, UnitedHealthcare, Cigna, Amerigroup, along with the BCBS licensee Horizon Blue Cross Blue Shield of New Jersey. Each payer's claims routing, timely filing, and prior-auth rules differ — see the per-payer guides linked above.
What Medicaid managed-care organizations operate in New Jersey?
NJ FamilyCare (New Jersey Medicaid) contracts with 5 Medicaid MCOs tracked in the QuickIntell registry, including Horizon BCBS NJ, UnitedHealthcare, Amerigroup, WellCare, Aetna. MCO contracts determine claims routing and appeal deadlines — route each claim by the member's MCO assignment, not by the FFS payer ID.
What state-specific billing regulations apply in New Jersey?
New Jersey has 3 tracked state-level statutes that affect medical billing and RCM: NJSA 26:2SS-1 et seq. (Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act, 2018); NJAC 11:22-1 (prompt payment of health benefits claims — 30 days electronic clean claim); NJ A-4676 (hospital charity care / medical debt reform). These sit on top of federal protections such as the No Surprises Act, HIPAA, and 42 CFR §447.45.
Run cleaner claims in New Jersey with QuickIntell
QuickRCM, QuickAuth, and QuickERA are tuned to NJ FamilyCare (New Jersey Medicaid) and the commercial payers on this page — eligibility, prior auth, claim scrubbing, and ERA posting all run on real payer rules, not generic adapters.
Disclaimer
This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. State Medicaid policies, MCO contracts, and payer rules change without notice — always verify against the current provider manual from New Jersey Medicaid and the member ID card before submission.