NJ Medicaid Providers Get Ready For Revalidation

Pursuant to the requirements imposed by the Affordable Care Act (ACA), New Jersey Division of Medical Assistance and Health Services (DMAHS) is beginning a revalidation process of all NJ FamilyCare (NJFM) fee-for-service (FFS) providers.

As of March 25, 2011, Federal regulation began requiring all States to complete revalidation of enrollment for all providers, regardless of provider type, every five years (three years for DME providers). Pursuant to this requirement, DMHAS will begin the revalidation/re-enrollment process of NJFC FFS providers who were enrolled in NJFC prior to January 1, 2013 and anticipates to complete this process by no later than March 2016.

The revalidation/re-enrollment process will be handled by Molina Medicaid Solutions, the State’s fiscal agent.  Thirty days prior to revalidation/re-enrollment, providers will receive a written notice informing them of the process. Providers must comply with the information and document request as set out in the revalidation/re-enrollment packet.

Failure to return the requested materials by the mandatory return date set out in the revalidation/re-enrollment packet will result in pended and/or denied claims due to the termination of a provider’s enrollment number. According to DMAHS, “the return of a completed re-enrollment packet is required for providers participating in any State program administered in whole or in part by DMAHS.”

Revalidation fees may apply to certain institutional providers ($542 for calendar year 2014 ). An abridged list of providers who must pay the application fee (or otherwise seek a waiver) include: pharmacies, DMEs, ambulatory surgical centers, FQHCs, independent labs, mental health/substance abuse clinics, portable x-ray providers, Medicare certified HHAs, and transportation providers. This fee applies to each service location upon intial enrollment, revalidation/re-enrollment or change of ownership.

If you have questions about the revalidation/re-enrollment process, Medicaid or Medicare participation, or have other legal questions, please contact us.