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Senior Services News Vol. 7, No. 02
New Jersey Medicaid·NJ · Geriatrics·Prior Authorization
Effective date
Mar 1, 2003
We identified it
Jun 20, 2026
Summary
New Jersey's Medicaid fiscal agent (Unisys) has revised crossover claims processing for nursing facilities. Effective immediately, Medicare Remittance Advices (RAs) must include three specific fields (net reimbursement, co-insurance amount, and covered days) or claims will be denied. The RUG rate calculation methodology has been refined to improve accuracy of Medicaid co-insurance payments. Paper submission of Medicare RAs is now required; electronic processing is no longer available.
Action Required
Immediately: Nursing facilities must verify that all Medicare Remittance Advices submitted to Unisys include three mandatory fields: (A) net reimbursement or provider payment amount, (B) co-insurance amount, and (C) covered days. Billing team must transition from electronic to paper submission of crossover claims and include a copy of the Medicare RA with all required billing documentation. Update internal claim submission procedures and staff training to ensure compliance. Verify that submitted RAs contain all three fields before forwarding to Unisys to prevent claim denials. Contact the Office of Provider Relations at 609-588-2874 with any questions.