New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 49 - ADMINISTRATION MANUAL
Subchapter 7 - SUBMITTING CLAIMS FOR PAYMENT POLICIES AND REGULATIONS
Section 10:49-7.1 - General provisions
Current through Register Vol. 56, No. 18, September 16, 2024
(a) The following information outlines the policies and regulations of the New Jersey Medicaid/NJ FamilyCare program that the provider shall adhere to when submitting a claim and requesting payment for services provided to a New Jersey Medicaid/NJ FamilyCare beneficiary. (To identify a Medicaid/NJ FamilyCare beneficiary, see N.J.A.C. 10:49-2.)
(b) In addition to information in this subchapter about submitting claims for payment, a Fiscal Agent Billing Supplement is included following each Provider Services Manual. Included in the Supplement are prior authorization forms and instructions; information for the proper completion and submission of claim forms; the procedure to follow when claims are rejected and returned to the provider by the Fiscal Agent during the adjudication process; third party liability verification, procedure for submitting crossover claims, and examples of timely submission of claims; electronic media claims (EMC) submission; Remittance Advice Statements; procedures for Electronic Funds Transfer (EFT); adjustments for overpayment of claims, and adjustments by Medicare; procedure to follow when a claim is paid in error (voids); procedure for inquiries about claims; procedure for ordering forms; information about provider services; and item-by-item instructions for completing the claim form and other forms.