MedicaidBilling CodesHigh impact
Newsletter Vol. 24, No.12
New Jersey Medicaid·NJ·Reimbursement
Effective date
Oct 1, 2015
We identified it
Jun 20, 2026
Summary
New Jersey is requiring all NJFC/Charity Care providers to transition from ICD-9-CM/PCS diagnosis and procedure codes to ICD-10-CM/PCS codes effective October 1, 2015. Claims submitted with service dates on or after this date must use ICD-10 codes; claims with earlier service dates must continue using ICD-9 codes. The state is offering a testing environment through Molina Medicaid Solutions to allow providers to validate their ICD-10 coding before the mandatory compliance deadline.
Action Required
By October 1, 2015: Billing team must update all billing systems, software, and claim submission processes to use ICD-10-CM diagnosis codes (3-7 alphanumeric digits) and ICD-10-PCS procedure codes (7 alphanumeric digits) for all NJFC FFS/Charity Care/HMO claims with service dates on or after this date. All claims with service dates prior to October 1, 2015 must continue reporting ICD-9-CM/PCS codes. Immediately: Providers should test ICD-10 compliant claims in the Molina EDI Proof System (www.njmmis.com) by submitting test files with ISA 15 field set to 'T', limited to 100 FFS/Charity Care claims or fewer than 1000 HMO encounter claims per file, using Version 5010 HIPAA standards. DO NOT mix ICD-9 and ICD-10 codes within the same claim. Ensure all ICD-10 codes are coded at the most granular level possible or claims will receive Error Code 0296 and be denied. Failure to submit ICD-10 coded claims on or after October 1, 2015 will result in claim denials by Molina for NJFC/Charity Care programs. Contact Molina EDI Department at (609) 588-6051 for technical support or Robert Brookwell at Robert.Brookwell@dhs.state.nj.us for ICD-10 coding questions.