MedicaidAdministrativeHigh impact
Newsletter Vol. 21, No.27
New Jersey Medicaid·NJ·Provider Notice
Effective date
Jan 1, 2012
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid is mandating a transition from HIPAA 4010A1 to HIPAA 5010A2 837I transaction format for institutional claim submission, effective January 1, 2012. Claims submitted on or after December 30, 2011 must use the new 5010 format, and all outpatient claims must use HCPCS surgical procedure codes instead of ICD-9 codes.
Action Required
By December 29, 2011: Billing team and software vendors must convert all institutional claim submission systems from HIPAA 4010A1 837I to HIPAA 5010A2 837I format. Update billing software to reject ICD-9 surgical procedure codes on all outpatient claims and require HCPCS surgical procedure codes instead. Test system conversion before December 30, 2011 cutoff. Consult the HIPAA 5010 Companion Guide at www.njmmis.com (Forms and Documents tab) for detailed technical specifications. Claims submitted December 30, 2011 or later in the old 4010 format will be rejected and denied. Contact Molina Medicaid Solutions Provider Services at 1-800-776-6334 with implementation questions.