MedicaidAdministrativeMedium impact
Newsletter Vol. 21, No.16
New Jersey Medicaid·NJ·Provider Notice
Effective date
Jul 1, 2011
We identified it
Jun 20, 2026
Summary
HMS has been designated as New Jersey's Medicaid Recovery Audit Contractor (RAC) effective July 1, 2011, with authority to conduct automated and complex claim reviews for potential overpayments with a 3-year lookback period. Providers subject to audit will receive detailed findings and have appeal rights through HMS.
Action Required
Immediately: All New Jersey Medicaid providers should ensure claim documentation and billing practices are compliant as HMS may conduct audits on claims from the past 3 years. Maintain detailed medical records and billing documentation. If audited, follow appeal instructions in HMS result letters. Direct questions to HMS at http://www.medicaid-rac.com/contact-hms or NJRAC@HMS.com.