MedicaidReimbursementHigh impact
Newsletter Vol. 20, No. 13
New Jersey Medicaid·NJ · Emergency Medicine·Provider Notice
Effective date
Jul 1, 2010
We identified it
Jun 20, 2026
Summary
Effective July 1, 2010, New Jersey Medicaid eliminated preferential Medicare rate reimbursement for ambulance services (BLS emergency, non-emergency, and specialty care transport) provided to dual Medicare/Medicaid eligible recipients. Instead, NJ Medicaid will now supplement Medicare payment using standard third-party liability rules, capping the total reimbursement at what Medicaid would pay as the primary payer.
Action Required
By July 1, 2010 (retroactive): Billing team must update ambulance service billing protocols to reflect new supplemental payment methodology for dual Medicare/Medicaid beneficiaries in New Jersey. (1) Modify billing system to eliminate Medicare rate reimbursement requests for NJ Medicaid dual-eligible claims; (2) Ensure ambulance claims for these beneficiaries are processed under standard third-party liability supplement rules per N.J.A.C. 10:49-7.3; (3) Verify that total reimbursement (Medicare + Medicaid supplement) does not exceed the Medicaid-only payment rate; (4) Update internal billing documentation and provider agreements to reflect the change. Failure to comply will result in claim denials and potential overpayment recovery for claims submitted under the old methodology.