Becoming a Medicaid/NJ FamilyCare Provider

March 03, 2021

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 full 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>>

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:
Sally O'Brien
Director of Behavioral Health
609.282.8232
o'briens@aetna.com       
---------
Billing Issues:
Liarra Sanchez
Behavioral Health Network Relations
Consultant, Provider Experience
609.455.8997
SanchezL7@aetna.com      
Contracting:
Lynda Grajeda
732.623.5801
Lynda.Grajeda@Amerigroup.com
---------
Clinical:
Ann Basil
732.623.5835
Ann.Basil@Amerigroup.com 
---------
For Authorization:
800.454.3730

For Claim Status and Explanation of Payment Remittances, access the secure provider portal or call 800.454.3730.
Contracting:  
Denise Mizell
856.638.3538 x735

Lauren Woods
973.466.6690
---------
For Utilization Management: (escalations only) 
Sarah Disanto
sarah_disanto@horizonblue.com  
---------
For Authorization:
800.682.9094 
---------
Behavioral Health Administrator:
Vincent Visioli
Vincent_Visioli@horizonblue.com  
---------
For Billing Concerns:
Nadine Assouman, Provider Resolution Analyst
973.466.4492
Contracting:
Catherine Wadsworth
Specialty Network Manager 
Catherine.Wadsworth@optum.com 
888.362.3368 
Contracting Provider Relations: 
Evelyn Terry
Evelyn.Terry@wellcare.com
Phone: 862.229.4453
---------
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 our Public Policy Director, Eric Eberman at eeberman@autismnj.org.

To receive updates and additional information, join our email list:


Originally posted 4/21/2020