Welcome to the Optum Network!
United Healthcare Community Plan, No Medicaid ID Claim Denials
The 21st Century Cures Act (Cures Act) 114 P.L. 255 requires all States to screen and enroll all Medicaid providers, both those in Medicaid fee-for-service (FFS) and managed care organizations (MCOs). Medicaid managed care network providers, regardless of specialty, are required to be screened by and enrolled with the State Medicaid Agency. Federal laws enforced by CMS, including the Affordable Care Act and the 21st Century Cures Act, require states to screen and enroll all providers. Providers who do not comply with this requirement risk being removed from the New Jersey Medicaid managed care network.
Beginning January 1,2023 claims will deny for providers not registered with Medicaid or who do not have a Medicaid ID. The Medicaid provider enrollment process is to ensure appropriate and consistent screening of providers and improve program integrity. You can register with Medicaid by enrolling as a fee for service provider or through the 21st Century Cures Act. More information can be found by visiting the NJMMIS website Welcome to New Jersey Medicaid 2 (njmmis.com)
NJ provider technology requirements FAQ
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If you have questions or need help, please contact provider services at (888) 362-3368
Optum Network Manual
Clinical Criteria
Best Practice Guidelines
Coordination of Care (COC)
Additional information and forms are available, including psych/neuropsych testing guidelines, credentialing plans, and Disability Solutions Manual, on the Provider Express Guidelines/Policies & Manuals and Optum Forms pages.
New Jersey Medicaid Resources
New Jersey Medicaid Programs – Quick Reference Guide
New Jersey Medicaid Provider Manual Addendum
New Jersey Office-Based Addiction Treatment
New Jersey Partial Care Prior Authorization Training
New Jersey OTP Medicaid Training
New Jersey Medicaid Facility Provider HEDIS®. FUH Presentation
New Jersey Medicaid Out Patient Provider HEDIS®. Measures Presentation