MedicaidReimbursementHigh impact
Newsletter Vol. 3, No. 16
New Jersey Medicaid·NJ·Provider Notice
Effective date
Jun 1, 2024
We identified it
Jun 20, 2026
Summary
Effective for hospital inpatient discharges on or after June, New Jersey Medicaid is changing how it calculates reimbursement when Medicaid is not the primary payer. Instead of prorating charges as a percentage of total charges, Medicaid will now reimburse based on what it would have paid absent other insurance, minus all other insurance payments (including Medicare). Billing teams must update UB claim form completion to properly sequence payers and enter covered charges and prior payments in the correct fields.
Action Required
By June 1, 2024: Billing team must implement new UB claim form completion procedures for all Medicaid hospital inpatient claims involving secondary or tertiary payers. REQUIREMENTS: (1) Update billing software and staff training to discontinue proration methodology; (2) Implement new calculation method: Medicaid payment = (Medicaid allowable amount) - (all other payer payments including Medicare); (3) Ensure UB form completion follows new field requirements: Field 1 = Total Charges for each revenue center, Field 2 = Charges covered by each payer in payer order, Fields A/B/C = Primary/Secondary/Tertiary payer codes, Fields A/B/C = Prior payments from respective payers; (4) For claims with more than 3 payers, prepare second UB form and staple together with all EOB statements and required attachments, mailing to Paramax Unisys (CN 025, Trenton NJ); (5) Contact questions to Medicaid fiscal agent Paramax Unisys Provider Services Unit. Failure to implement the new calculation methodology will result in improper reimbursement and claim denials. Route this directive to Chief Executive Officer, Hospital Accounting, Billing, and Finance offices.