MedicaidAdministrativeHigh impact
Newsletter Vol. 11, No. 60
New Jersey Medicaid·NJ·Coding
We identified it
Jun 20, 2026
Summary
New Jersey has issued guidance prohibiting balance billing of Medicaid/NJ FamilyCare beneficiaries for covered services. Healthcare providers cannot bill patients for the difference between their charges and Medicaid reimbursement rates.
Action Required
Immediately: Billing team must review all Medicaid/NJ FamilyCare patient accounts to ensure no balance billing is occurring for covered services. Update billing system settings to prevent automatic patient billing for Medicaid covered services beyond approved copays/deductibles. Train staff on prohibited balance billing practices to avoid compliance violations.