MedicaidAdministrativeHigh impact
Newsletter Vol. 35, No.02
New Jersey Medicaid·NJ·Reimbursement
Effective date
Jan 1, 2025
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid is implementing PERM (Payment Error Rate Measurement) audits effective January 1, 2025, requiring NJ FamilyCare Fee-For-Service providers to respond promptly to random medical records requests from a contractor. Providers must submit documentation proving claim appropriateness based on state guidelines, medical necessity, coding accuracy, and service delivery, with failure to respond resulting in potential sanctions, payment suspensions, or provider termination.
Action Required
By January 1, 2025: (1) Billing team and providers must ensure all contact information is current with Gainwell Technologies (State Fiscal Agent) at 1-800-776-6334 to receive PERM audit notifications. (2) All billing staff must establish a process to respond to PERM Review Contractor (PERM RC) phone calls and immediately route 'Medical Records Request Letters' to appropriate staff. (3) Implement a tracking system for PERM audit requests and establish tight turnaround protocols for medical records submission to the PERM RC—do NOT delay responses. (4) Providers must verify that all claims documentation includes: adherence to state guidelines, complete medical records, medical necessity justification, proof services were delivered as ordered, and accurate coding. (5) Legal/compliance should review HIPAA authorization (45 C.F.R. 164.512(d)) to confirm staff understand PHI disclosure is permitted for this audit. (6) All providers must complete PERM education using resources provided (PERM Provider Education FAQs, PERM Overview for Providers Webinar). CONSEQUENCES: Failure to respond to audit requests or comply with findings may result in provider suspension, eligibility termination, payment denials, and civil monetary penalties.