MedicaidAdministrativeHigh impact
Newsletter Vol. 3, No. 08
New Jersey Medicaid·NJ·Provider Notice
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid has established a formal reconciliation procedure for medical equipment claims that were downgraded (e.g., electric bed to manual bed) by Medicare or Medicaid. Medical suppliers must now use a specific NJ claim form with HCPCS code X and supporting documentation (Medicare EOB, Medicaid RA, prior authorization, and pricing evidence) submitted to Paramax Unisys to request payment reconsideration. Claims submitted without complete documentation will be denied.
Action Required
Immediately: Billing team must implement new reconciliation workflow for downgraded Medicare/Medicaid medical equipment claims. (1) Update billing procedures to use NJ claim form (not standard claim forms) for all downgrade reconciliation requests. (2) Train billing staff to enter HCPCS code X in Field D with narrative 'Reconciliation of Downgraded Claim' and provider's usual and customary charge in Field G. (3) For Garden State Health Plan members, require prior authorization number from physician case manager in specified block. (4) Establish quality assurance process to verify all required attachments are included before submission: Medicare EOB statement, Medicaid RA statement, prior authorization evidence from Medicaid District Office, and invoice/price list (if BY Report item). (5) Direct all reconciliation claims to Paramax Unisys Corporation, CN, Trenton NJ, Attention Department A. Failure to include complete pricing and Medicare payment documentation will result in claim denial and delayed reimbursement.