MedicaidReimbursementHigh impact
Newsletter Vol. 22, No.08
New Jersey Medicaid·NJ · Nephrology·Provider Notice
Effective date
May 7, 2012
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid (NJMMIS) updated reimbursement rules for End Stage Renal Disease (ESRD) services effective May 7, 2012. Claims for ESRD bundled services will now be reimbursed at the 8XX revenue code composite rate only, with all other revenue codes denied via edit 1322. Prior to January 1, 2011, separately billable drugs (63X revenue codes) remain reimbursable alongside the bundled rate.
Action Required
By May 7, 2012: Billing team must update claims submission process for all ESRD services billed with Type of Bill 72X to Molina Healthcare. For dates of service on or after January 1, 2011, submit only 8XX revenue codes for the ESRD bundled rate; all other revenue codes will be denied with edit 1322. For dates of service prior to January 1, 2011, submit 8XX revenue codes for the bundled rate AND 63X codes for separately billable drugs; deny all other revenue codes. Update billing software edits and staff training materials to reflect the new adjudication rules. Modify claim submission templates to ensure compliance. Failure to comply will result in claim denials for non-compliant revenue codes.