MedicaidAdministrativeHigh impact
Newsletter Vol. 21, No.12
New Jersey Medicaid·NJ·Provider Notice
Effective date
Jan 1, 2012
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid is mandating an upgrade from HIPAA 4010A1 to HIPAA 5010 transaction formats for all claim submissions, effective January 1, 2012. Providers must obtain 5010 certification, complete EDI agreements, and update billing software to submit claims in the new format; claims submitted after December 30, 2011 in the old 4010A1 format will be rejected.
Action Required
By December 30, 2011: Billing team and software vendors must (1) obtain a 5010 certification certificate from an ASC X12-approved vendor (EDIFECS, Ingenix/Claredi, eMergence, Foresight, or AppLabs Technologies); (2) complete and submit the 5010 EDI Agreement (for new submitters) or 5010 EDI Agreement Addendum (for current submitters) to Molina Medicaid Solutions via www.njmmis.com under "Forms and Documents" tab; (3) update billing software to generate claims in HIPAA 5010 format (837 Professional [005010X222A1], 837 Institutional [005010X223A2], 837 Dental [005010X224A2], 835 Payment/Advice [005010X221A1], and 820 for HMOs [005010X218]); (4) test 5010 compliance with Molina before January 1, 2012. Beginning December 31, 2011, all claims submitted to Molina in the legacy 4010A1 format will be rejected and not processed. Note: 837 Institutional claims will not be accepted into production until ICD-9 to HCPCS procedure code conversion project is complete. Contact Molina Provider Services at 1-800-776-6334 with questions.