MedicaidAdministrativeMedium impact
Newsletter Vol. 1, No. 04
New Jersey Medicaid·NJ·Provider Notice
We identified it
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.
Action Required
Immediately: Billing team and providers must acknowledge and prepare for audit activities from Blue Cross and Blue Shield of New Jersey Inc representatives. Ensure 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. Maintain documentation practices for hospital inpatient billings, DRG assignments, and claims involving potential third-party liability. Direct any audit-related questions to Leon R. Bartol, Chief Bureau of Administrative Control. Failure to cooperate with audits may result in claim denials or compliance issues.