MedicaidAdministrativeHigh impact
Newsletter Vol. 19, No. 15
New Jersey Medicaid·NJ·Medical Policy
Effective date
Apr 1, 2009
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid now requires providers submitting electronic claims with private Third Party Liability (TPL) denials to attach an Explanation of Benefits (EOB) and HIPAA Cover Sheet. Claims lacking this documentation will be pended with Adjustment Reason Code 16 and Remark Code MA04 until the EOB is provided and reviewed.
Action Required
By April 1, 2009: Billing team must implement the following workflow for all electronic claims with private TPL coverage denials: (1) Obtain and attach the EOB from the primary payer; (2) Download the HIPAA Attachment Cover Sheet from www.njmmis.com (Forms and Documents > HIPAA > HIPAA Attachment Cover Sheet); (3) Submit the cover sheet with attached EOB to Unisys; (4) Do not resubmit claims until EOB review is complete. Update claim submission procedures and staff training to ensure compliance. Claims submitted without EOB attachments will be pended indefinitely with Adjustment Reason Code 16 and Remark Code MA04, delaying reimbursement. Contact Unisys Provider Services at (800) 776-6334 with questions.