Becoming a Medicaid/NJ FamilyCare Provider
March 03, 2021
 | Health Insurance and Autism Series. |  |
Information for Providers
As of April 1, 2020, NJ FamilyCare covers ABA services for children birth to 21 years, a much anticipated benefit for children on Medicaid. Read Medicaid’s announcement for additional details. This article provides information about how providers can enroll to offer this important benefit.
Are you a family? Learn more about accessing this benefit>>
Waiting too long for ABA for your child to begin? Learn more about prompt access to treatment>>
Medicaid Process
Provider agencies that are not currently approved Medicaid/NJ Family Care providers must do the following:
STEP 1: Obtain a Medicaid Provider Number
STEP 2: Contact the MCOs to complete their contracting process
Both steps can be done simultaneously, but please be aware that the contracting process with the MCOs may need to pause until the Medicaid Provider ID number is obtained.
Obtaining a Medicaid Provider Number
Complete the ASD Treatment Provider Application for all provider types and the Addendum. Email, fax, or mail the application, addendum, and required credentials to:
Email: Njmmisproviderenrollment@dxc.com
Fax: 609.584.1192
Mail: Gainwell Provider Enrollment, P.O. Box 4804, Trenton, NJ 08650
Inquiries related to completion of the application and addendum may be directed to Gainwell Provider Enrollment at 609.588.6036.
For any questions or concerns about this benefit, providers should call 609.599.8522 or email MAHS.ASDinquiries@dhs.nj.gov.
Contact the MCOs to complete their contracting process
Each MCO has its own requirements. Please inquire directly at the numbers listed below:
| MCO | Contact Information |
|---|---|
 | Clinical Issues: Maressa Nordstrom Behavioral Health Administrator 609.613.2386 nordstromm1@aetna.com --------- Billing Issues: Liarra Sanchez Behavioral Health Network Relations Consultant, Provider Experience 609.455.8997 SanchezL7@aetna.com |
 | Contracting: Join Our Network 800.454.3730 --------- Clinical: Ann Basil 732.713.7636 Ann.Basil@Amerigroup.com --------- For Authorization: www.availity.com 800.454.3730 Library of Amerigroup Forms Fax: 844.442.8007 For Claim Status and Explanation of Payment Remittances, access the secure provider portal or call 800.454.3730. |
 | Contracting: Denise Mizell 856.638.3538 Lauren Woods 973.466.6690 Network Relations BHNetworkRelations@horizonblue.com --------- For Utilization Management: (escalations only) Erin McNeill Erin_McNeill@horizonblue.com 732.256.6336 --------- For Authorization: 800.682.9094 --------- Behavioral Health Administrator: Sonya Lee sonya_lee2@horizonblue.com --------- For Billing Concerns: Nadine Assouman, Provider Resolution Analyst 973.466.4492 |
 | Contracting and Billing: Catherine Wadsworth Specialty Network Manager Catherine.Wadsworth@optum.com --------- 888.362.3368 |
 | Contracting Provider Relations: Jennifer Huang Jennifer.Huang1@wellcare.com Phone: 813.206.2251 Stacy Felder stacy.felder@wellcare.com Phone: 862.229.4292 --------- Utilization Management: Becky Barkhurst Rebecca.Barkhurst@wellcare.com O: 813.206.7704 --------- Care Management: Kim Brown-Jones Kimya.Brown@wellcare.com O: 973.274.2141 | C: 862.229.4132 Noralisa Santiago Noralisa.Santiago@wellcare.com O: 973.274.2166 | C: 862.240.2495 |
Currently serving children through DCF/CSOC/PerformCare?
For providers already contracted with an MCO, the provider needs only to seek an authorization to provide and bill for ABA services. For those who are not contracted with an MCO, the provider must contact their client’s MCO to inquire about becoming credentialed or request a single case provider agreement for their client.
We’re Here for You
Autism New Jersey continues to work closely with Medicaid and CSOC/PerformCare on this benefit. If you have questions, concerns, or feedback, please contact publicpolicy@autismnj.org.
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Originally posted 4/21/2020
