MedicaidAdministrativeHigh impact
Newsletter Vol. 2, No. 15
New Jersey Medicaid·NJ·Provider Notice
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid has updated requirements for completing Field 81 on the UB-92/HCFA claim form for inpatient hospital DRG claims. The field must contain exactly 14 characters in a specific order: medical record number (positions 1-9), readmission status (position 10), DRG number (positions 11-13), and outlier indicator (position 14).
Action Required
Immediately: Billing team must update UB-92/HCFA claim form completion procedures for inpatient DRG claims to ensure Field 81 contains exactly 14 characters in the specified order. Train staff on proper formatting: positions 1-9 (medical record number with trailing zeros if less than 9 characters), position 10 (readmission status: 0=No, 1=Yes, 9=Unknown), positions 11-13 (3-digit DRG number), position 14 (outlier indicator using specified codes). Failure to complete this field properly will cause claims to suspend, deny, or be reimbursed incorrectly requiring claim adjustments.