MedicaidAdministrativeHigh impact
Newsletter Vol. 23, No.05
New Jersey Medicaid·NJ·Provider Notice
Effective date
Feb 20, 2013
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid is updating the McKesson ClaimCheck® Solution to transition from Medicare NCCI auditing to Medicaid NCCI auditing effective February 20, 2013. This change implements Medically Unlikely Edits (MUEs) and CCI Incidental Edits to prevent improper code combinations and overpayments on NJFamilyCare/Medicaid fee-for-service claims.
Action Required
By February 20, 2013: Billing team must verify that all claim submission systems and software are updated to reflect the transition from Medicare NCCI to Medicaid NCCI edits. Review ClaimCheck® software configuration to ensure Medically Unlikely Edits (MUEs) and CCI Incidental Edits are active. Train billing staff on the new Medicaid NCCI edit pairs to prevent claim denials due to improper code combinations. Monitor initial claim submissions after the effective date for rejections related to code pair violations. Reference the CMS Medicaid NCCI website (http://www.medicaid.gov) for complete edit pair specifications. Failure to comply will result in increased claim denials and payment delays for NJFamilyCare/Medicaid FFS claims.