Materials and forms for Providers | Aetna Medicaid New Jersey

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Provider materials and forms

Materials

Provider manual (PDF)

Quick reference guide (PDF)

Member Care Information Portal user guide (PDF)

Provider pocket guide: Preventing falls in older patients (PDF)

New Jersey Reproductive Health Access Project Toolkit (PDF) (New Jersey Health Care Quality Institute)

Doula services (PDF) - For more information visit: https://www.state.nj.us/humanservices/dmahs/info/doula.html or click here (PDF)

Doula application form (PDF)

English (PDF)
Chinese (PDF)
Hindi (PDF)
Portuguese (PDF)
Spanish (PDF)
Tagalog (PDF)

Forms

Primary care physician (PCP) re-assignment request form (PDF)

Prior authorization request form (includes managed long-term services and supports (MLTSS) custodial requests) (PDF)

Behavioral Health Prior Authorization Form (PDF)

Prior authorization request form for medical equipment/supplies (PDF)

Provider spot check questionnaire (PDF)

Medical day care/personal care assistant service authorization request form (PDF)

Personal care assistant (PCA) nursing assessment tool (PDF)

Hysterectomy receipt of info form (PDF)

Managed long- term services and supports (MLTSS) critical incident reporting form (PDF)

Critical Incident Training Attestation Form (PDF)

Sterilization consent form (PDF)

Women, Infants and Children (WIC) health care referral form (PDF)

Universal credentialing application (PDF)

Disclosure of ownership (PDF)

Fluoride varnish application attestation form (PDF)

Orthodontic assessment tool for comprehensive treatment (PDF)

Oral health risk assessment tool (PDF)

Caries risk assessment form - for members above age 6 (PDF)

Caries risk assessment form - for members under age 6 (PDF)

Helpful websites

Agency for Healthcare Research and Quality

Medical Home Improvement

Milliman Care Guidelines (MCG)

Case Management Society of America (CMSA)

National Committee for Quality Assurance (NCQA) health plan accreditation

U.S. Preventive Services Prevention TaskForce tools for primary care clinicians

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