MedicaidAdministrativeHigh impact
Newsletter Vol. 12, No. 46
New Jersey Medicaid·NJ·Provider Notice
Effective date
Oct 16, 2003
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid is implementing HIPAA-compliant electronic transaction standards (837 Version 4010, 835 Version 4010, and NCPDP Version 5.1) with a mandatory compliance deadline of October 16, 2003. All providers submitting electronic claims must upgrade their billing software to HIPAA specifications or face claim rejection. This policy also establishes implementation timelines for additional HIPAA transaction sets (276/277, 270/271, 278, 820, 834, 275) and notifies providers of pending HIPAA privacy and security rule requirements.
Action Required
By October 16, 2003: All providers who submit electronic claims to New Jersey Medicaid must upgrade billing software to support HIPAA-compliant transaction formats (837 Version 4010 for claims, 835 Version 4010 for remittance advice, and NCPDP Version 5.1 for pharmacy). Immediately: Contact billing agents/electronic submitters to verify software upgrades are scheduled and in progress. Submit a HIPAA compliance plan to CMS by October 16, 2002 (if not already submitted by New Jersey Medicaid on your behalf) to qualify for the extended deadline. Before October 16, 2003: Update all billing workflows, claim submission processes, and system configurations to use HIPAA standard transaction sets exclusively. Stop submitting claims in non-HIPAA formats. Failure to comply will result in all non-HIPAA formatted electronic claims being rejected by New Jersey Medicaid effective October 16, 2003.