MedicaidBilling CodesHigh impact
Newsletter Vol. 32, No.10
New Jersey Medicaid·NJ·Coding
Effective date
Apr 1, 2022
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid/NJ FamilyCare FFS now requires application of CMS National Correct Coding Initiative (NCCI) edits to all healthcare claims, effective immediately. Claims violating NCCI procedure-to-procedure (PTP) edits will be denied with Error Code 1885, and claims exceeding Medically Unlikely Edits (MUEs) will be denied with Error Code 1878. Billing teams must align all claim submissions with NCCI methodology or face automatic denials.
Action Required
Effective immediately: (1) Billing team must review all current claim submission processes and identify code combinations that may violate NCCI PTP edits by consulting CMS guidelines at https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/PTP-Coding-Edits. (2) Update billing software and claim scrubbing rules to enforce NCCI PTP edits—prevent submission of unbundled code pairs that should not be reported together. (3) Configure system to enforce MUE limits—set maximum units of service per code per date of service based on NCCI methodology. (4) Train billing and coding staff on NCCI requirements and the two denial error codes: Error Code 1885 (PTP conflict) and Error Code 1878 (MUE exceeded). (5) Implement a monthly audit process to review denied claims with these error codes and correct coding patterns. (6) Communicate changes to all providers in the practice and require compliance with NCCI edits when reporting codes. Failure to comply will result in automatic claim denials with no reimbursement from NJ Medicaid/NJ FamilyCare FFS.