MedicaidAdministrativeMedium impact
Medicaid Alert MA2017-01
New Jersey Medicaid·NJ·Provider Notice
Effective date
Oct 1, 2015
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid has identified incorrect DRG grouping and payment issues for inpatient hospital claims since ICD-10 implementation on October 1, 2015, due to faulty 3M mapping software. The state will automatically recycle and reprocess affected claims through August 2017 to correct payment errors.
Action Required
Monitor for automatic claim reprocessing through August 2017. Claims with discharge dates October 1, 2015 - September 30, 2016 will be recycled by end of May 2017. Claims with discharge dates October 1, 2016 - July 2017 will be recycled by end of August 2017. Review reprocessed payments for accuracy and use existing appeal process for any remaining DRG assignment disputes after August 2017.