MedicaidAdministrativeMedium impact
Medicaid Alert MA2017-03
New Jersey Medicaid·NJ · Geriatrics, Palliative Care·Provider Notice
Effective date
Aug 15, 2017
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid is now reporting cost share amounts (patient responsibility for Long Term Services and Supports) directly in eMEVS system responses, effective August 15, 2017. Billing teams must verify that MCO claim deductions match the eMEVS-reported cost share amounts and follow a new dispute resolution process for discrepancies.
Action Required
REQUIREMENTS:
- By August 15, 2017 (effective date): Billing team must begin cross-referencing all MCO claim payments for LTSS (nursing facility and assisted living facility services) against the cost share amounts displayed in eMEVS to identify discrepancies.
- Implement verification process: After each MCO payment, confirm the amount deducted matches the eMEVS cost share amount for that beneficiary/service period.
- For unresolved discrepancies: Billing staff must send encrypted email to provider-inquiries@dhs.state.nj.us with: beneficiary ID, MCO member ID, service type, service period, eMEVS cost share amount, and MCO payment deduction amount. Do not delay—contact MCO first to attempt resolution.
- Update billing workflows to flag claims where cost share deductions differ from eMEVS display by more than $0 without explanation.
- Retain documentation of all cost share discrepancies and resolution attempts for audit purposes.
- Failure to track cost share accuracy may result in underpayment claims and revenue loss.