MedicaidAdministrativeMedium impact
Newsletter Vol. 34, No.04
New Jersey Medicaid·NJ·Prior Authorization
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid (DMAHS) has established a Fair Hearing Appeal Process specifically for Permedion Utilization Review audit adverse determinations on inpatient MCO encounters. This provides a formal appeals pathway when Permedion denies or reduces payment for inpatient stays after audit review.
Action Required
Immediately: Billing and appeals teams should review the new Fair Hearing Appeal Process procedures for Permedion UR audit denials. Update denial management workflows to include this appeals pathway for inpatient MCO encounter adverse determinations. Train staff on the specific appeal requirements and timelines outlined in Newsletter Vol. 34, No.04.