New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 49 - ADMINISTRATION MANUAL
Subchapter 8 - PAYMENT FOR SERVICES PROVIDED
Section 10:49-8.3 - Adjustments following payment of claims
Current through Register Vol. 56, No. 18, September 16, 2024
(a) If a claim is incorrectly paid, so that the provider receives an overpayment or underpayment, within 60 days of such receipt, the provider shall correctly adjust the claim by utilizing the web-based claims resolution process or another approved method of automated data exchange, unless an attachment to the claim is required, in which case the provider shall instead use an MMIS Claim Adjustment Request Form, (FD-999). (For the procedure to follow, see Fiscal Agent Billing Supplement following the second chapter of each Provider Services Manual). However, a provider shall immediately adjust all incorrectly overpaid claims that are discovered subsequent to the expiration of the 60-day deadline, also utilizing the web-based claims resolution process or another approved method of automated data exchange, unless an attachment to the claim is required, in which case the provider shall instead use an MMIS Claim Adjustment Request Form (FD-999).
(b) On occasion, a claim will be paid that should not have been paid. If a claim is paid in error, within 60 days of such receipt, the provider shall utilize the web-based claims resolution process or another approved method of automated data exchange to void the claim. (For the procedure to follow, see the Fiscal Agent Billing Supplement following the second chapter of each Provider Services Manual.) However, a provider shall immediately void all claims paid in error that are discovered subsequent to the expiration of the 60-day deadline, also utilizing the web-based claims resolution process or another approved method of automated data exchange.
(c) Any adjustment made by Medicare will not cross over to Medicaid. If Medicare makes an adjustment that results in an overpayment or underpayment by Medicaid, within 60 days of receipt of any such overpayment or under payment, the provider shall notify the Fiscal Agent. (For the procedure to follow, see the Fiscal Agent Billing Supplement following the second chapter of each Provider Services Manual).
