MedicaidReimbursementHigh impact
Medicaid Alert MA-2024-03
New Jersey Medicaid·NJ·Provider Notice
Effective date
Jan 1, 2025
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid (NJ FamilyCare) is transitioning from AP-DRG Version 34 to APR-DRG Version 41 for inpatient hospital reimbursement, effective January 1, 2025. This change includes implementation of national DRG weights calibrated for budget neutrality. All acute care general hospitals must update their billing systems and coding processes to reflect the new grouper and reimbursement methodology.
Action Required
By December 31, 2024: Billing team and patient account managers must (1) Update all billing software and DRG grouper systems to utilize APR-DRG v41 instead of AP-DRG v34 for all inpatient hospital discharges; (2) Download and implement the national DRG Weights available on NJMMIS.COM under the DRG Pricing Header and Rate and Code Information Link; (3) Verify that the billing system correctly maps inpatient cases to APR-DRG v41 codes and applies the updated weights; (4) Test claim submission workflows to ensure all discharges on or after January 1, 2025 are grouped and reimbursed under the new methodology; (5) Communicate the change to all clinical documentation and coding staff to ensure accurate documentation for APR-DRG assignment. Failure to implement this change will result in claim denials or incorrect reimbursement for all Medicaid inpatient discharges after the effective date. Contact MAHS.Hospitalissues@dhs.nj.gov or 609-434-2379 with questions.