Medical Billing Services in New Jersey
New Jersey practices bill Novitas Solutions for Medicare. NJ FamilyCare, the state's Medicaid program, pays through five managed care organizations (MCOs) and a fee-for-service program run through NJMMIS, and the filing deadlines are different for each. We handle billing for New Jersey practices remotely across 15+ specialties.
Who Pays Medical Claims in New Jersey
Who pays what in New Jersey.
Jurisdiction L
New Jersey Part A and Part B claims go to Novitas Solutions, A/B MAC Jurisdiction JL, which also covers Delaware, the District of Columbia, Maryland and Pennsylvania. Home health and hospice claims are the exception: CMS assigns New Jersey's to Wellpoint Federal (Jurisdiction 6). DME claims go to DME MAC Jurisdiction A, run by Noridian Healthcare Solutions.
NJ FamilyCare (DMAHS)
Run by the Division of Medical Assistance and Health Services (DMAHS) in the New Jersey Department of Human Services. Fee-for-service claims go to the state's fiscal agent through NJMMIS, where providers also check eligibility in eMEVS.
Five MCOs
DMAHS contracts with Aetna Better Health of New Jersey, Fidelis Care, Horizon NJ Health, UnitedHealthcare Community Plan and Wellpoint (formerly Amerigroup New Jersey). DMAHS tells providers to confirm eligibility every month, along with the member's plan and any active authorization.
We confirm each patient's plan at eligibility and re-check it as the member's coverage changes. Commercial and Medicare Advantage plans are billed under their own contracts.
New Jersey Medicaid Billing Rules to Know
From DMAHS provider guidance and state regulation. Each MCO also publishes its own manual.
180 days for MCO claims
Under the NJ FamilyCare managed care contract, providers submit claims within 180 calendar days of the date of service and corrected claims within 365 days of the date of service.
Secondary claims
When another insurer is primary, coordination of benefits claims are due within 60 days of the primary insurer's explanation of benefits or 180 days from the date of service, whichever is later.
Fee-for-service runs on a different rule
For claims paid directly by Medicaid, N.J.A.C. 10:49-7.2 requires the fiscal agent to receive non-institutional claims within one year of the date of service (inpatient hospital claims from discharge), with EPSDT and pediatric HealthStart claims due within 30 days. A denied claim can be resubmitted within one year of service or 30 days of adjudication, whichever is later.
Sources: NJ DMAHS Essential Information for NJ FamilyCare Providers (2026); NJ FamilyCare Health Plans page; N.J.A.C. 10:49-7.2; NJ DMHAS Behavioral Health Integration materials; CMS Who Are the MACs.
What Makes New Jersey Medical Billing Different
The recent shift that affects New Jersey claims.
Why behavioral health billing moved in New Jersey
NJ FamilyCare has been moving behavioral health into managed care in phases. Outpatient mental health and substance use disorder services moved on January 1, 2025, SUD lab testing on July 1, 2026, and SUD residential, medically monitored withdrawal management and opioid treatment programs are scheduled for January 1, 2027. Those services now go to the member's MCO, each with its own claims rules and the 180-day limit. With five MCOs to choose from and eligibility to confirm monthly, getting the front end right is most of the job. Our claim submission work covers that hand-off.
What We Handle for New Jersey Practices
The billing work we do for New Jersey Medicaid, Medicare and commercial accounts.
Eligibility checks that confirm the MCO or fee-for-service status each month
Prior authorization requests and tracking with each MCO
Medical coding and charge review
Claims to Novitas, the five MCOs, NJMMIS and commercial payers
Denial management, appeals and A/R follow-up
Payment posting, patient statements and monthly reporting
Specialties We Support in New Jersey
15+ specialties served, including the behavioral health and substance use services now billed to MCOs.
New Jersey Medical Billing Questions
Common questions from New Jersey practices.
Who processes Medicare claims in New Jersey?
Novitas Solutions handles Part A and Part B as the A/B MAC for Jurisdiction JL. Home health and hospice claims go to Wellpoint Federal (Jurisdiction 6), and DME claims go to Noridian Healthcare Solutions as DME MAC Jurisdiction A.
How long do I have to file a New Jersey Medicaid claim?
For NJ FamilyCare managed care plans, 180 calendar days from the date of service, with corrected claims due within 365 days. For fee-for-service claims, N.J.A.C. 10:49-7.2 gives one year for non-institutional claims. We confirm which one applies to the member.
Do I bill NJMMIS or the MCO?
If the member is enrolled in an MCO, the claim goes to that MCO. NJMMIS takes fee-for-service claims. We check enrollment at eligibility.
Did behavioral health billing change in New Jersey?
Yes. Outpatient mental health and substance use disorder services moved to managed care on January 1, 2025, SUD lab services on July 1, 2026, and more SUD services are scheduled for January 1, 2027.
Which specialties do you support for New Jersey practices?
Our 15+ supported specialties include behavioral health, laboratory, home health, hospice, infusion, sleep medicine, DME, dental, vision and ENT, including the behavioral health and substance use services New Jersey now routes to MCOs.
Can Salyx RCM bill for my New Jersey practice remotely?
Yes. We connect to your practice management or billing software with secure access and work remotely.
Get a Clear Read on Your New Jersey Claims
Start with a free billing audit: a review of your recent claims, denials and A/R, with a summary of what we found.