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Have any questions?

Healthfirst NJ
821 Alexander Road, Suite 140
Princeton, NJ 08540

Want to become a Healthfirst NJ Medicare member? Have a question about our benefits? Contact us at:
1-877-237-1308
TDD/TTY English
1-800-852-7897
TDD/TTY Español
1-866-658-7714
Monday - Friday, 8 a.m. to 6 p.m.

Already a Healthfirst NJ
Medicare member? For
answers to your questions, contact us at:

1-877-GO4-HFNJ
(1-877-464-4365)
TDD/TTY English
1-800-852-7897
TDD/TTY Español
1-866-658-7714
Monday - Sunday, 8 a.m. to 8 p.m.

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Provider Forms

In our ongoing effort to make the administrative side of your practice as simple as possible, below you will find many commonly used Healthfirst NJ authorizations and request forms.
 
Don’t see the form you need? Just call Provider Services at 866-889-2523.

Pharmacy

Healthfirst Global Prescription Exception Form for NJ Medicaid

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Preventive Care

Healthfirst NJ Care Management Referral Form

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Base Abuse Screening for the Elderly (BASE)

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Screening for Elder Abuse and Neglect PDF icon image
Lead Level Notification Form PDF icon image
OB Notification Form PDF icon image
Nutrition Assessment for Women Form   PDF icon image
EPSDT Form PDF icon image

Outpatient and Ancillary Forms

PCA FAX Cover Sheet PDF icon image
PCA Assessment Tool PDF icon image
ADHS Authorization Request PDF icon image

Member Forms

Medicare Member Forms PDF icon image

Other Provider Forms

HFNJ LTC Facility Disenrollment Request PDF icon image
Notification from Long Term Care Facility of Admission or Termination of a Medicaid Beneficiary PDF icon image
Medical Record Review   Standards Tool PDF icon image
NPI Submission Form  PDF icon image
Provider Alert: April 30-May 1, 2013 Interactive Phone System Issue PDF icon image
Advanced Directives (English / Español) PDF icon image
Advanced Directives Instructions (English / Español) PDF icon image

Behavioral Health

Emergent Admission Fax Form    PDF icon image

 

 

 

Last update 2014-07-15 13:26