MedicaidReimbursementHigh impact
Newsletter Vol. 11, No. 47
New Jersey Medicaid·NJ·Reimbursement
Effective date
Jun 1, 2001
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid and NJ FamilyCare Plan A will now reimburse providers for copayment amounts owed by dual-eligible beneficiaries (those enrolled in both Medicaid/NJ FamilyCare and Medicare or commercial HMO coverage). Providers must submit claims with specific documentation, mark copayment amounts clearly on claim forms, and include Explanation of Benefits from the primary payer to receive reimbursement.
Action Required
Immediately implement the following: (1) Billing team must update claim submission procedures to require Explanation of Benefits (EOB) documentation from HMO/MCO for all copayment reimbursement claims. (2) For all claim types (HCFA-1500, MC-6, MC-9, MC-10, MC-12, MC-19), add the word 'copayment' to the designated remarks/notes field per the chart in the policy. (3) Update billing system to ensure only the actual copayment amount is entered in the 'charge(s)' field—no other values permitted. (4) Configure system to require the appropriate HMO insurance carrier code in the 'other health insurance coverage' field; reference fiscal agent billing supplement for correct codes. (5) Ensure all claims are submitted within the one-year timely filing deadline from date of service. (6) Train all billing staff on these requirements to prevent claim denials. Failure to follow these requirements will result in claim rejections and non-reimbursement of copayment amounts.