MedicaidAdministrativeMedium impact
Newsletter Vol. 24, No.06
New Jersey Medicaid·NJ · Emergency Medicine, Critical Care, Psychiatry·Prior Authorization
Effective date
Jan 1, 2014
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid has relaxed utilization review error rate thresholds from 3% to 5% and simplified administrative day billing requirements for hospitals with patients awaiting non-nursing facility placement. Hospitals now only need to meet 2 out of 4 previous requirements for administrative day reimbursement when patients no longer need acute care but are awaiting discharge to group homes or other non-nursing facilities.
Action Required
Immediately: Hospital billing teams in New Jersey should update utilization review processes to reflect the new 5% error rate threshold instead of 3%. For administrative day billing, when patients are awaiting placement to non-nursing facilities, only verify that stipulations 1-2 are met: (1) all other health insurance benefits have been utilized and (2) discharge planning was initiated upon admission and regularly updated. Continue to satisfy all 4 stipulations only for patients awaiting nursing facility placement.