Credentialing in New Jersey
Soft Home Global provides payer enrollment, revalidation and follow-up for New Jersey practices and billing companies at $2,200 per seat per month. Full time, worked during New Jersey business hours, inside your own system.
What is specific to New Jersey
NJ FamilyCare runs through managed care organizations with their own enrollment queues.
New Jersey’s Medicaid program is NJ FamilyCare. Practices with a meaningful NJ FamilyCare mix usually need it worked as its own queue rather than mixed into commercial follow-up, because the submission path, the timely filing window and the appeal route are all different.
Medicare here is adjudicated by Novitas Solutions, jurisdiction JL — shared with Delaware and Pennsylvania, but not with New York (National Government Services). CMS publishes the jurisdictions; checked September 2026.
What a credentialing seat does in New Jersey
Applications, revalidations and payer follow-up, with every enrollment's status visible.
NJ FamilyCare is not one enrollment but one per plan, and every one of them has a revalidation date that stops payment when it passes. That calendar is the work.
- Initial applications prepared and submitted
- Revalidations tracked ahead of the deadline
- CAQH kept current
- Payer follow-up until an effective date is issued
- Status of every enrollment visible to you
- Worked during New Jersey business hours, not queued overnight
For the statute behind all of this — New Jersey’s prompt-pay deadline, its Medicaid filing limit, and the wrinkle that catches people out here — see the New Jersey billing page.
NJ FamilyCare, in practice
NJ FamilyCare moved off fee-for-service starting in 1995 and is now delivered through managed care: five MCOs participate statewide — Aetna Better Health of New Jersey, Fidelis Care, Horizon NJ Health, UnitedHealthcare Community Plan, and Wellpoint (formerly Amerigroup New Jersey). Source: State of New Jersey
Auto-accident care is a separate, state-controlled billing track: New Jersey is a no-fault PIP state, and under the N.J.A.C. 11:3-4 Medical Protocols Rule every provider treating a PIP patient must file Decision Point Review and precertification requests on the state's Uniform Attending Provider Plan Form, and bill against New Jersey's Automobile Medical Fee Schedule rather than any health-plan fee schedule. DOBI states: 'All providers treating PIP patients must use the Uniform Attending Provider Plan Form to submit Decision Point and Precertification Requests to Insurers.' Source: State of New Jersey
For enrolment that is not a detail, it is a second application. A carved-out benefit is administered by a different organisation, which credentials separately, on its own timetable, and a provider who is live everywhere else can still be out of network for that one service without anybody noticing until the first claim is denied.
How long you have to file a NJ FamilyCare claim
1 year from the date of service (non-institutional); 1 year from discharge (inpatient). A denied claim: within one year of the date of service or 30 days of adjudication, whichever is later.
“One year of the date of service” N.J.A.C. 10:49-7.2 — Timeliness and method of Medicaid claim or other claim submission
A claim past that date is not late, it is unpayable, and no appeal recovers it. It is the one queue where a week of nobody working it is money that does not come back — which is the argument for working NJ FamilyCare as its own queue rather than mixing it into commercial follow-up. Every state’s limit is listed here.
For enrolment that window is the whole risk. A provider seeing patients before their NJ FamilyCare enrolment completes is accruing dates of service they cannot bill yet, and whether those dates are recoverable depends on two things: how far back the effective date is granted, and whether the filing limit above has already passed by the time the enrolment lands. A retro-effective date that arrives after the window has closed recovers nothing. That is the arithmetic worth doing before a new provider starts, not after.
Working New Jersey hours
New Jersey runs on Eastern time, 10 hours behind our floor in Rawalpindi. To be at a desk for your nine to five, the shift here runs 7pm to 3am, and 6pm to 2am once the clocks go forward. Pakistan does not observe daylight saving, so the shift moves on this side rather than yours.
That is the part that decides whether follow-up happens at all: a payer’s phone lines are open on New Jersey hours and nobody else’s.
What it costs in New Jersey
$2,200
Per seat, per month, in US dollars — $26,400 a year for one full-time person, forty hours a week, on New Jersey hours. No annual contract, no percentage of collections, no setup fee and no software to buy. Seat prices across all roles in New Jersey run $1,500 to $2,500; the full list is published.
That is the entire invoice. Run your own figures against a percentage vendor or a hire rather than take ours.
Getting started in New Jersey
About a week from a signed agreement to a person working your queue, and that week of training is not billed on top. The week, step by step, and what is signed before anyone has access.
If working with staff outside the United States is new to your practice, see how a medical billing company structures that seat and why offshore medical billing does not have to mean losing visibility into the work.
Questions
Do you work with New Jersey practices?
Yes. New Jersey accounts are worked during New Jersey office hours rather than queued overnight, because a payer's phone lines are open then and at no other time.
What is different about New Jersey?
NJ FamilyCare runs through managed care organizations with their own enrollment queues.
How long do we have to file a NJ FamilyCare claim?
1 year from the date of service (non-institutional); 1 year from discharge (inpatient), measured from the date of service. A denied claim: within one year of the date of service or 30 days of adjudication, whichever is later. Past that date a claim is not late, it is unpayable, and no appeal recovers it. Source: N.J.A.C. 10:49-7.2 — Timeliness and method of Medicaid claim or other claim submission.
Which Medicare Administrative Contractor covers New Jersey?
Novitas Solutions, the A/B MAC for jurisdiction JL. It processes Medicare enrollment applications for providers here, and it sends the revalidation notice two to three months before the due date.
When does a New Jersey payer have to pay a clean claim?
30 calendar days for electronic clean claims; 40 calendar days for paper (non-electronic) clean claims. Interest accrues from day 31 / day 41. It runs from receipt of a clean claim, so claims held back while a provider’s enrollment is pending have not started it.
How often do New Jersey providers have to revalidate?
Medicare: every five years, with sixty days to submit once Novitas sends the notice (42 CFR 424.515). NJ FamilyCare: federal rule requires the state to revalidate every provider at least every five years (42 CFR 455.414), and the state agency sets the exact schedule. A Medicare revalidation left unanswered deactivates billing privileges, and claims stop with it.
How much does credentialing cost in New Jersey?
$2,200 per seat per month — $26,400 a year for a full-time person, forty hours a week. Every seat price is published at softhomeglobal.com/pricing.
What hours will somebody actually be working our New Jersey queue?
New Jersey is on Eastern time, 10 hours behind Rawalpindi. The shift here runs 7pm to 3am so your seat is at a desk for your full working day, shifting to 6pm to 2am while daylight saving is in force — Pakistan does not observe it, so the change happens on our side.
Do you handle NJ FamilyCare as well as commercial payers?
Yes, and as its own queue rather than mixed into commercial follow-up. NJ FamilyCare has its own submission path, its own filing window and its own appeal route, and working it in the same worklist as commercial claims is how the deadlines get missed.
Is this a percentage of what you collect?
No — a flat monthly rate per seat, published at softhomeglobal.com/pricing. A percentage bills you most in your best month and points the vendor at the easy accounts.
More for New Jersey
Next step
One seat on your New Jersey work
Twenty minutes on a call is enough to tell whether this fits. If it does not, I will say so.
Or write to ops@softhomeglobal.com