Welcome New Jersey Providers 

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 21^st 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 21^st Century Cures Act. More information can be found by visiting the NJMMIS website Welcome to New Jersey Medicaid 2 (njmmis.com)

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We're here to help

If you have questions or need help, please contact provider services at (888) 362-3368

Optum Network Manual

• Network Manual

Clinical Criteria

• Standard Clinical Criteria

Best Practice Guidelines

• BP Guidelines

Coordination of Care (COC)

• COC Flyer
• COC Checklist

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