MedicaidDocumentationHigh impact
Newsletter Vol. 3, No. 34
New Jersey Medicaid·NJ · Geriatrics, Palliative Care·Provider Notice
Effective date
Aug 1, 2024
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid is reactivating edit code enforcement for nursing facility admissions effective August 2024. Nursing facilities must now have a Pre-Admission Screening (PAS) record on file from the Medicaid District Office before admitting Medicaid-eligible patients, or claims will be denied. Facilities must submit MCNH forms promptly and ensure correct HSP Medicaid Case Numbers are recorded to avoid claim rejections.
Action Required
By August 1, 2024: Nursing facility billing teams must implement the following changes: (1) Verify that every Medicaid admission has a Pre-Admission Screening (PAS) approval letter from the Medicaid District Office BEFORE processing claims; (2) Ensure MCNH (Notification from Long-Term Care Facility of Admission or Termination of Medicaid Patient) forms are submitted to the MDO within required timeframes (at admission and for private-to-Medicaid conversions); (3) Verify that the correct HSP Medicaid Case Number is recorded on all MCNH forms and communicated to the MDO for entry into the PAS subfile; (4) Update billing system workflows to flag claims lacking PAS records before submission; (5) Train admissions and billing staff on PAS requirements. For Garden State Health Plan (GSHP) members, confirm disenrollment from GSHP before processing claims. Failure to comply will result in claim denials with edit code 'No PAS Assessment On File' appearing on Remittance Advice. Contact the appropriate Medicaid District Office (directory provided in policy) with questions.