MedicaidAdministrativeHigh impact
Medicaid Alert - MA2016-03
New Jersey Medicaid·NJ·Provider Notice
Effective date
Nov 1, 2016
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid is enforcing stricter National Provider Identifier (NPI) reporting requirements for Division of Developmental Disabilities (DDD) and Community Care Waiver (CCW) claims, effective immediately. Billing teams must ensure each service location has a unique servicing provider NPI separate from the billing provider NPI, or claims will be denied with specific error codes. Both the 7-digit Medicaid billing provider ID and 10-digit NPI must be reported correctly on all claim submissions.
Action Required
Immediately: Billing team must audit all DDD and CCW claims to ensure proper NPI reporting. REQUIREMENTS: (1) Verify each servicing location has a unique 10-digit servicing provider NPI assigned and registered with Medicaid; (2) Update billing software to require servicing provider NPI field (Field 24J on 1500 forms) to be populated separately from billing provider NPI (Field 33a on 1500 forms); (3) For paper and DDE claims, ensure Field 33a contains 10-digit billing provider NPI and Field 33b contains 7-digit Medicaid billing provider ID; (4) For paper and DDE claims, ensure Field 24J contains both the 10-digit servicing location NPI and the 7-digit Medicaid billing provider ID (as servicing provider ID); (5) Correct any claims currently submitted with blank servicing provider NPIs or with servicing provider NPI matching billing provider NPI (unless services are delivered at billing address); (6) Brief all billing staff on error codes 1221 (missing servicing provider NPI), 1424 (no association found between billing/servicing NPIs), and 1429 (ineligible servicing provider NPI) and resubmission procedures. CONSEQUENCES: Non-compliant claims will be denied immediately with error codes; claims cannot be processed for payment until NPIs are corrected and resubmitted. Reference www.njmmis.com for additional error code details.