MedicaidAdministrativeHigh impact
Newsletter Vol. 23, No.15
New Jersey Medicaid·NJ·Coding
Effective date
Sep 1, 2013
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid/NJ FamilyCare has reiterated its strict prohibition on balance billing beneficiaries. Providers must accept Medicaid payments as payment in full and cannot bill patients for any additional charges, except in very specific circumstances requiring written patient consent and meeting multiple criteria.
Action Required
Immediately: Billing team must ensure no balance billing of Medicaid/NJ FamilyCare patients. Review all outstanding patient balances for Medicaid beneficiaries and write off any charges above Medicaid payment amounts. Update billing system rules to prevent balance billing Medicaid patients. Train staff that Medicaid payments must be accepted as payment in full, including for emergency services and MCO referrals.