MedicaidDocumentationHigh impact
Newsletter Vol. 31, No.27
New Jersey Medicaid·NJ · Critical Care, Psychiatry, General Surgery·Eligibility
Effective date
Jan 1, 2022
We identified it
Jun 20, 2026
Summary
New Jersey hospitals must now include specific data elements (diagnosis codes, procedure codes, sex, discharge status, date of birth, admission/discharge dates, skilled/residential care level indicators, and associated dates) on all UB-04 and HIPAA 837(I) inpatient claims submitted to NJ FamilyCare MCOs effective January 1, 2022. This change stems from audit findings that revealed gaps in required reporting for MCO adjudication and billing validation.
Action Required
By January 1, 2022: Billing team must audit and update all UB-04 and HIPAA 837(I) claim submission processes for NJ FamilyCare MCO claims to ensure the following data elements are captured and transmitted: Diagnosis Code(s), Procedure Code(s), Sex, Discharge Status Code, Date of Birth, Newborn Birth Weight, Admission Date, Discharge Date, Skilled level of Care (SNF) or Administrative Days with associated dates, and Residential level of Care (denied days) with associated dates. Update billing software validation rules, EMR templates, and hospital discharge/billing workflows to require these fields before claim submission. Notify hospital coders and billing staff of the new requirements. Failure to include these data elements will result in claim denials and audit findings for NJ FamilyCare MCO encounters.