Credentialing in New Jersey

NJ Medicaid (NJ FamilyCare) provider enrollment runs through NJMMIS. The NJ Department of Human Services runs Medicaid via DMAHS (policy/operations) with DMHAS as the behavioral-health unit. The NJMMIS provider enrollment page is the entry point for both full fee-for-service enrollment and the separate Cures Act network enrollment type.

NJMMIS, Provider Enrollment · checked Jul 2026

NJ FamilyCare runs through five MCOs: Aetna Better Health of New Jersey, Fidelis Care (formerly Wellcare), Horizon NJ Health, UnitedHealthcare Community Plan, and Wellpoint (formerly Amerigroup NJ). For behavioral health, DMHAS guidance is to credential and contract with all five.

NJ DHS/DMHAS, NJ FamilyCare Behavioral Health Integration Updates (2026-03-12) · checked Jul 2026

NJ's state claims training treats associates, LSW, LAC, LAMFT and LADC, as billable under supervision on the MCO side; they bill under a group or facility and are never individually credentialed. At Fidelis, UnitedHealthcare and Wellpoint the rendering field carries the 'Type 1 NPI of supervisor' (Aetna allows the supervisor's Type 1 NPI or the group's Type 2 NPI). Horizon NJ Health is the exception, 'Supervised billing is not permitted' for associates under individual/group billing; associate work at Horizon goes only through the licensed facility/agency path.

NJ DMAHS/DMHAS, Provider Claims Training Presentation (as of Oct 29, 2024) · checked Jul 2026

NJ is doing a PHASED carve-in of behavioral health from Medicaid FFS into the five NJ FamilyCare MCOs, not a completed 2025 switch. Phase 1 (live 2025-01-01) moved outpatient MH and SUD services for adults AND children to the MCOs; Phase 2 (MH supervised residential, SUD residential, inpatient withdrawal management, Opioid Treatment Programs) is delayed to 2027 and stays FFS until then; Phase 3 (including CCBHCs, Behavioral Health Homes, and Children's System of Care targeted case management) is still FFS with no date set. Match the service to its current phase: outpatient = MCO, residential/OTP/CSOC = FFS.

NJ DHS/DMHAS, NJ FamilyCare Behavioral Health Integration Updates (2026-03-12) · checked Jul 2026

A provider who only sees NJ FamilyCare MCO members must still be screened and enrolled with the state Medicaid agency, MCOs may not contract with providers who have not enrolled in NJMMIS. NJMMIS operationalizes this with a distinct '21st Century Cures Act' (and '21st Century Cures Act - Group') enrollment type, separate from full FFS-billing enrollment; Cures Act network enrollment does NOT authorize FFS billing. NJMMIS does not use 'Track A/B/C' labels, that nomenclature traces to a secondary industry blog, not the state.

NJMMIS, Provider Enrollment · checked Jul 2026

During each MCO's behavioral-health transition period the plan auto-approves prior authorizations and pays out-of-network at the Medicaid FFS floor. As of March 2026: Aetna's transition period ended 2025-11-01, Horizon's around 2026-04-01, and Fidelis, UnitedHealthcare and Wellpoint continue 'until further notice.' After an MCO exits transition, real medical-necessity PA review and potentially sub-FFS out-of-network pay apply, get in-network with all five before the cushion closes.

NJ DHS/DMHAS, NJ FamilyCare Behavioral Health Integration Updates (2026-03-12) · checked Jul 2026