MedicaidAdministrativeHigh impact
Medicaid Alert - MA2012-01
New Jersey Medicaid·NJ · Emergency Medicine, Critical Care·Provider Notice
Effective date
Sep 1, 2012
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid is implementing post-payment review audits for all hospital-based transportation services. Hospitals must ensure MICU/ALS and associated BLS ambulance services are billed on a single claim by the hospital providing the MICU/ALS service. Non-emergency BLS transportation after discharge must be coordinated through Logisticare, the state's transportation broker, not billed directly to Medicaid. Claims that do not meet these criteria will be voided.
Action Required
Immediately: Billing team must audit all transportation service claims submitted to NJ Medicaid/NJ FamilyCare to ensure compliance with N.J.A.C. 10:50-1.4. (1) Stop billing MICU/ALS and associated BLS ambulance services on separate claims—these must be submitted on a single claim by the hospital providing MICU/ALS service only. (2) Do not bill non-emergency BLS transportation services (including post-discharge transport) directly to Medicaid; coordinate these through Logisticare instead. (3) Instruct transportation companies contracted with the hospital to bill the hospital directly for BLS services associated with MICU/ALS runs, not Medicaid. (4) Update billing software and claim submission procedures to enforce single-claim requirements for MICU/ALS combinations. Failure to comply will result in DMAHS voiding non-compliant claims during post-payment review audits.