New Jersey: Denied claims will no longer be automatically reprocessed
Last modified: July 8, 2024
Update: Added codes and descriptions to “Claims denial codes” list
21st Century Cures Act participants should follow the claim reconsideration process
Starting July 1, 2024, you will need to submit a claim reconsideration if you are registered for the 21st Century Cures Act program and want us to reprocess a denied claim. Previously, we were automatically reprocessing denied claims.
Reconsideration process
If you aren’t currently registered with the 21st Century Cures Act program, go to Avoid claim denials for New Jersey Medicaid for instructions.
After you complete your registration with the state, follow the claim reconsideration process and include a copy of the approval letter from the state.
Claim reconsideration process – If you believe we incorrectly denied a claim or should reconsider the claim, use the claim reconsideration process. This will allow us to review the claim based on additional information or documentation.
Attach state approval letter – When submitting the claim reconsideration, attach a copy of the approval letter you received from the state. The approval letter is evidence of your registration completion and supports the reconsideration request.
By following the claim reconsideration process, you can help ensure your claim is properly reviewed and considered for payment.
Claim denial codes
If your claim is denied because you are not registered, you will see 1 of the following denial codes on your remittance advice:
| Denial code | Denial code description |
|---|---|
| QSA | Billing Provider validation issue |
| QSC | Rendering Provider validation issue |
| QSF | Referring Provider validation issue |
| QSG | Servicing Provider validation issue |
| QSJ | Attending Provider validation issue |
| QSL | Operating Provider validation issue |
| QSN | Other Provider validation issue |
| QSV | Ordering Provider validation issue |
| QSX | Supervising Provider validation issue |
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PCA-1-24-02038-POE-NN_07032024
