NJ FamilyCare
Administered by New Jersey Department of Human Services through NJMMIS (New Jersey Medicaid Management Information System).
New Jersey Revenue Cycle Management
Medical billing for New Jersey practices — NJ FamilyCare, Medicare, and commercial payers.
New Jersey's Medicaid billing runs through New Jersey Department of Human Services, and every managed-care plan has its own rules. We bill NJ FamilyCare, Medicare, and New Jersey's commercial payers correctly the first time — and follow every denial through to resolution.
The New Jersey payer landscape
Managed-care plans
- Horizon NJ Health
- Aetna Better Health of New Jersey
- UnitedHealthcare Community Plan
- Wellpoint
- Fidelis Care [VERIFY]
Dominant commercial payers
- Horizon Blue Cross Blue Shield of New Jersey
- Aetna
- Cigna [VERIFY]
Why New Jersey claims get denied
- Wrong NJ FamilyCare managed-care plan on file at time of service among five active MCOs
- NJMMIS claim rejected for a provider taxonomy or NPI enrollment mismatch [VERIFY]
- Prior authorization missing for a service that specific MCO requires but another doesn't
- Out-of-network claims denied when a client's plan changed mid-benefit-year without re-verification
- Behavioral health carve-out routing errors between the MCO and the state's behavioral health vendor
New Jersey behavioral health billing
New Jersey's behavioral health benefit runs partly through each NJ FamilyCare MCO and partly through separate state contracts, so we verify which structure applies to a given client's plan before billing to avoid a carve-out routing denial [VERIFY].
Credentialing comes first
Enrollment through NJMMIS plus applications to each of the five major NJ FamilyCare MCOs is a heavier lift than most states — see our New Jersey credentialing page for the full sequence.
See New Jersey Credentialing →Billing and books together
Your New Jersey claims and your bookkeeping are handled by the same team, so collections, denials, and adjustments always tie back to your financials without a reconciliation gap between separate vendors.
Clearinghouses and EHRs we work in
AvailityOffice AllyWaystarTebraAdvancedMDSimplePracticeKipuTheraNestAveaICANotesBestNotes
5–7% of collections · $950/mo minimum — the same in every state.
Free analysis
Free New Jersey Revenue Leakage Analysis
Send a recent AR aging report and denial summary. We'll show you denial patterns by NJ FamilyCare plan, days in AR, and the fixes we'd make first.
Send de-identified reports only — we sign a Business Associate Agreement before any PHI is exchanged.