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Newsletter Vol. 18, No. 04
New Jersey Medicaid·NJ · Emergency Medicine, Orthopedics, General Surgery +1 more·Provider Notice
We identified it
Jun 20, 2026
Summary
New audits are being conducted for DRG assignment accuracy and trauma/third-party liability (TPL) claims. Providers should expect increased scrutiny of hospital billing and trauma cases with potential third-party payers.
Action Required
Immediately: Review all trauma cases for proper third-party liability identification and ensure accurate DRG assignment documentation. Billing teams should verify trauma claims identify all potential third-party payers (auto insurance, workers comp, etc.) before submission. Hospital billing staff must ensure DRG assignments have proper supporting documentation to withstand audit scrutiny.