Important Update: Claim Reconsideration Process for New Jersey Medicaid (21st Century Cures Act)
Previously, denied claims were automatically reprocessed. However, under the new system, participants will need to submit a formal claim reconsideration request if their claim is denied.
What You Need to Do:
- Register for the 21st Century Cures Act (if not already done): Individuals who haven’t registered yet should visit [link on how to avoid claim denials for NJ Medicaid] for instructions to avoid future claim denials.
- For Denied Claims: If your claim is denied after July 1st, follow the claim reconsideration process ([link to claim reconsideration process]) and include a copy of your state approval letter when submitting your request.
Why the Change?
This new process allows for a more thorough review of denied claims. By submitting a reconsideration request, you have the opportunity to provide additional information or documentation that may support your claim.
What to Look For:
If your claim is denied due to non-registration with the 21st Century Cures Act, you’ll see one of these denial codes on your remittance advice:
| Denial code | Denial code description |
| QSA | Billing Provider validation issue |
| QSC | Rendering Provider validation issue |
| QSG | Servicing Provider validation issue |
| QSJ | Attending Provider validation issue |
| QSL | Operating Provider validation issue |
Taking Charge of Your Healthcare
By registering for the 21st Century Cures Act (if applicable) and following the new claim reconsideration process, New Jersey Medicaid beneficiaries can ensure their claims receive a proper review and maximize their chances of receiving the coverage they deserve.
