MedicaidAdministrativeHigh impact
Newsletter Vol. 21, No.24
New Jersey Medicaid·NJ·Provider Notice
Effective date
Nov 1, 2011
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid/NJ FamilyCare is changing how providers report patient responsibility amounts (copayments, coinsurance, deductibles) on EPSDT and MC-19 claim forms. Effective immediately, providers must report patient responsibility amounts in Block 27 instead of the charge field, continue reporting other insurance payments in Block 17, and attach Explanation of Benefits documentation. Medicaid will now assume cost-sharing responsibilities for beneficiaries with Medicare HMO or other insurance coverage.
Action Required
IMMEDIATELY: Billing team must update claim submission procedures for all New Jersey Medicaid/NJ FamilyCare EPSDT-eligible services. (1) Stop reporting patient responsibility amounts as claim charges in the Charge field. (2) Start reporting patient responsibility amounts in Block 27 on MC-19 and EPSDT claim forms. (3) Continue reporting other insurance payments in Block 17. (4) Stop using the term 'copayment' on claim forms. (5) Attach Explanation of Benefits from other insurance to all paper claims with patient responsibility amounts. (6) Verify correct Insurance Carrier Codes are used on all claims to prevent denials. Update billing software validation rules, train all billing staff on new form completion requirements, and modify encounter forms/templates to ensure providers document patient responsibility amounts correctly. Failure to comply will result in claim processing delays and potential denials due to incorrect claim format.