← Back to list
Newsletter Vol. 1, No. 04
Act
immediately
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
Blue Cross and Blue Shield of New Jersey Inc has been awarded a contract to perform Medicaid and PAAD program audits previously conducted by DMAHS fiscal agents. This includes desk audits of pharmaceutical claims, DRG validation for hospital inpatient billing, and trauma-related claims with potential third-party liability. Providers should expect continued audit activities from Blue Cross and Blue Shield of New Jersey representatives acting as agents of DMAHS.
Get alerts when payers change rules like this one
We check New Jersey Medicaid and other payers every day and email you when a change matches your specialty and state.
Get New Jersey Medicaid alertsPolicy Monitoring is free. No card required.
What to do
immediately · 5 steps
01Billing team and providers must acknowledge and prepare for audit activities from Blue Cross and Blue Shield of New Jersey Inc representatives.
02Ensure all staff are aware that audits for Medicaid PAAD pharmaceutical claims, hospital inpatient DRG coding, and trauma-related claims will continue under the new contractor.
03Maintain documentation practices for hospital inpatient billings, DRG assignments, and claims involving potential third-party liability.
04Direct any audit-related questions to Leon R.
05Bartol, Chief Bureau of Administrative Control.
If missed: Failure to cooperate with audits may result in claim denials or compliance issues.
Original notice
Newsletter Vol. 1, No. 04
njmmis.com · Always check the source before changing claims.
Related changes
See all New Jersey Medicaid changes →Newsletter Vol. 1, No. 02MediumNo effective date · PharmacyNewsletter Vol. 1, No. 03HighEffective Nov 1, 1993 · Provider NoticeNewsletter Vol. 1, No. 1LowNo effective date · Provider NoticeNewsletter Vol. 1, No. 05HighNo effective date · CodingBrowse every New Jersey Medicaid change in the policy list