MedicaidAdministrativeMedium impact
Newsletter Vol. 11, No. 45
New Jersey Medicaid·NJ·Reimbursement
Effective date
Jun 1, 2001
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid/NJ FamilyCare will now reimburse providers for copayment amounts when beneficiaries have Medicare or commercial HMO as primary coverage. Providers must submit claims with specific documentation and use designated fields on UB-92 forms to receive copayment reimbursement.
Action Required
Immediately: New Jersey hospital billing teams must update UB-92 claim submission procedures: (1) Include 'copayment' in field 84 remarks, (2) Enter actual copayment amount only in field 55, (3) Use correct payer codes in field 50 (015 for Medicare HMO outpatient, 011 for inpatient, 017 for professional component), (4) Attach Explanation of Benefits from primary HMO/MCO with each copayment claim, (5) Submit within current timely filing limits. Claims without proper documentation will be denied with edit code 880.