MedicaidAdministrativeMedium impact
Newsletter Vol. 32, No.26
New Jersey Medicaid·NJ·Provider Notice
Effective date
Dec 5, 2022
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid is replacing its ClaimCheck® claims auditing system with ClaimsXten® software effective December 5, 2022. The new system will continue applying the same NCCI edits but introduces three new edit codes that may result in different claim denial reasons.
Action Required
By December 5, 2022: Billing team must update claim denial tracking systems to recognize new ClaimsXten® edit codes (1855/958 for Add on edit, 1856/968 for Missing modifier 26, and 1860/969 for Procedure to diagnosis coverage). Review denied claims for these new edit codes and ensure proper modifier usage, especially modifier 59 and NCCI-associated modifiers, with appropriate medical record documentation. Contact Gainwell Technologies at 1-800-776-6334 for questions about new denial codes.