MedicaidAdministrativeHigh impact
Medicaid Alert - MA-2009-02
New Jersey Medicaid·NJ·Provider Notice
Effective date
Apr 6, 2009
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid (NJ FamilyCare) will no longer accept the outdated CMS-1500 12/90 edition claim form. All hardcopy claims submitted to fiscal agent Unisys must use the CMS-1500 Revised 8/05 edition effective April 6, 2009. Claims submitted on the old form after this date will be returned to the provider.
Action Required
By April 6, 2009: Billing team must immediately transition from CMS-1500 12/90 edition claim forms to CMS-1500 Revised 8/05 edition for all hardcopy submissions to Unisys (NJ FamilyCare/Medicaid fiscal agent). Update all billing software, templates, and provider ordering systems to use only the revised 8/05 form. Include NPI number on all claims when known, though it is not required on paper claims. Verify all providers have access to the new form. Notify all staff that any claims submitted on the old 12/90 form after April 6, 2009 will be rejected and returned, causing payment delays. Electronic HIPAA-formatted claims are unaffected. This change applies only to hardcopy submissions.