MedicaidAdministrativeMedium impact
Newsletter Vol. 3, No. 26
New Jersey Medicaid·NJ·Provider Notice
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid has clarified reimbursement policies for Medicare Part B professional component services provided by hospital-employed physicians to dual-eligible patients. Hospitals must now submit claims on hardcopy UB forms with specific payer codes and attachments to receive Medicaid reimbursement for Medicare deductibles and coinsurance.
Action Required
Immediately: New Jersey hospitals must update billing procedures for dual-eligible Medicare/Medicaid patients. Use hardcopy UB (HCFA) claim forms for professional component deductible/coinsurance claims. Enter Payer Code in Field A/B/C and corresponding deductible amounts. Attach Medicare Part B EOBs to all claims. For previously denied claims with error codes or paid claims missing deductible/coinsurance billing, resubmit according to new requirements or file FD Adjustment Request Forms.