MedicaidAdministrativeHigh impact
Newsletter Vol. 24, No.01
New Jersey Medicaid·NJ·Provider Notice
Effective date
Apr 1, 2014
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid is mandating transition from the 1500 (08/05) claim form to the 1500 (02-12) form effective April 1, 2014. The new form accommodates ICD-10 codes, adds an ICD indicator field, supports up to 12 diagnosis codes (vs. 7), and changes provider ID qualifiers from '1D' to 'G2'. Claims submitted on the old form after March 31, 2014 will be rejected.
Action Required
By March 31, 2014: Billing team must update all claim submission processes to use only the 1500 (02-12) form for NJ FamilyCare/Medicaid FFS claims. Immediately update billing software to: (1) use provider ID qualifier 'G2' instead of '1D' in fields 17a, 24i, and 33b; (2) include ICD indicator value ('9' for ICD-9, '0' for ICD-10) in field 21; (3) support up to 12 diagnosis codes in field 21; (4) ensure diagnosis pointers in field 24e (A-L, max 4 per line) correlate with field 21 diagnoses; (5) remove/discontinue use of field 30 (Balance Due). Notify all providers in practice to stop submitting old 1500 (08/05) forms. Test new form submissions in billing system before April 1. After March 31, any claims on old form will be returned by Molina Medicaid Solutions and require resubmission. By October 1, 2014: All claims with service dates on/after Oct 1 must use ICD-10 diagnosis codes only (replace ICD-9 indicator '9' with ICD-10 indicator '0'). Train billing staff on new form requirements. Verify Direct Data Entry (DDE) system has been updated by fiscal agent to accept new ICD indicator and G2 qualifier. Contact Molina Medicaid Solutions at 1-800-776-6334 with questions.