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Gainwell Technologies
Provider Services
1-800-776-6334
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Click here for ICD 10 Resources.
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Revised: A revised DMAHS Disclosure of Ownership Form (FD-452) dated May 2023 has been published replacing the current FD-452 Form. All provider application packages have been updated with the May 2023 version of the form FD-452. For any documentation received on or after January 1, 2024, only the most recent version of the FD-452 (05/2023) will be accepted. The current version of the Disclosure of Ownership form is now also available for download in the Forms & Documents section on njmmis.com.
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P.L. 2018, Chapter 136 and N.J.A.C. 10:52B establish the New Jersey County Option Hospital Fee Pilot Program to support local hospitals and to ensure that they continue to provide necessary services to low-income residents. The Act limits eligibility to a maximum of seven counties and delineates criteria for eligibility. The below information and documents are for the use of eligible counties and the hospitals within their borders.
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Click here for COVID-19 rates and codes.
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For COVID-19 questions and information please go to:
Department of Health COVID-19 public health information: https://www.nj.gov/health/cd/topics/ncov.shtml.
Department of Human Services COVID-19 program updates: https://nj.gov/humanservices/coronavirus.shtml.
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Long Term Acute Care Hospital Providers: This notice serves to announce that New Jersey Medicaid’s NJ FamilyCare program will now enroll Long Term Acute Care Hospitals (LTACHs) as NJ FamilyCare providers. LTACHs providers will not be reimbursed for NJ FamilyCare Fee-for-Service client services, the provider enrollment process will allow LTACHs providers to submit claims for bad debt for dual eligible (Medicare and Medicaid) client health services.
To enroll, providers should contact the Gainwell Provider Enrollment Unit at 609-588-6036, or via the njmmis.com website. To obtain a provider enrollment application via the website, from the Home Page click the link on the left side for “Provider Enrollment Application,” click the drop down menu and select “Provider Type” then select “Hospital.” From here you can choose to download the application, or you can request a blank application be mailed to you. Note: If you choose to have the application mailed to you, you will need to complete the Provider Information portion of the webpage.
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Attention New Jersey Acute Care Inpatient Hospital Providers. NJ FamilyCare Will Be Transitioning From the 3M AP-DRG Grouper Version 27 to the 3M APR-DRG Grouper Version 34 for New Jersey Acute Care Inpatient Hospital Reimbursement Effective With Discharge Dates on and After October 1, 2018. Click here for Information and Updates on this Transition.
Below are the questions and answers from the May 17th APR Transition webinar "APR Q&A"
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The NJ FamilyCare program will continue to price inpatient claims using the AP version 27 grouper upon implementation of ICD-10 code reporting. The grouper, used in conjunction with the most current 3M mapper, allows ICD-9 or ICD-10 codes from one year to be used with a grouper from another year, in determining the correct DRG for inpatient pricing.
Hospital providers and their vendors are encouraged to test fee-for-service and Hospital Care Payment Assistance Program (ECPS/Charity Care) inpatient claims for ICD-10 compliance now. Information and instructions on ICD-10 testing opportunities offered by NJ Familycare and NJ Hospital Care Payment Assistance Program can be found in Newsletter Volume 24 #12.
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Providers with questions regarding the Electronic Data Interchange (EDI) process may contact the Gainwell Technologies EDI Unit at 609-588-6051. The EDI Unit is prepared to respond to questions regarding how to submit claims through a clearinghouse or directly; how to request a submitter ID number; turnaround times; and reasons for claim payments being rejected. For additional information, providers are encouraged to access the 837/835/277P HIPAA Companion Guide (Version 5010), Section 8, which may be found at www.njmmis.com; select ‘Forms & Documents’; key ‘provider’; key ‘HIPAA’; select the 837/835/277P HIPAA Companion Guide (Version 5010) form the documents list. In addition, providers can download EDI applications from the same listing of documents. Choose ‘EDI 201 Submitter/Provider Agreement’ for providers establishing a submitter/provider relationship (clearinghouse relationship); or ‘EDI 801 Electronic Remittance Agreement’ for providers requesting receipt of an electronic remittance advice statement.
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Important Information for Providers and Submitters about NPI Mapping
Click here to access Important information regarding NPI mapping
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Payment Error Rate Measurement (PERM) - Accessing Information
Click here to access information relating to Payment Error Rate Measurement (PERM) processing.
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Payment Error Rate Measurement (PERM) - Important Information
Click here for important information regarding Payment Error Rate Measurement (PERM).
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The Gainwell Technologies Provider Services Department provides comprehensive training services to the provider community. The Provider Training Unit educates and updates providers on current Medicaid billing procedures, problems and claim processing. The training sessions are held at Gainwell Technologies, provider sites, or other locations throughout the State of New Jersey. For inquires or to register for training, contact the Gainwell Technologies Provider Call Center at 1-800-776-6334.
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HIPAA Companion Guides. For a copy of any of the latest Guides, right mouse click on one of the following links, select the 'Save Target As...' option from the pop-up menu, and then specify the location on your hard drive where the file should be saved.
5010 HIPAA Companion Guide (6592 KB) Updated December 2024
837/835/277P Technical Update (104 KB) refreshed for next "as needed update"
5010 HIPAA 270/271 Companion Guide (932 KB, for MEVS Switch Vendors only) Upd December 2022
270/271 Technical Update (82 KB) refreshed for next "as needed update"
Pharmacy NCPDP D.0/1.2 Payer Sheet (1659 KB) Updated November 2023
NCPDP D.0/1.2 Technical Update (88 KB) refreshed for next "as needed update"
5010 HMO Systems Guide (8638 KB) Updated April 2024
HMO Encounters Technical Update (86 KB) refreshed for next "as needed update"276/277 5010 HIPAA Companion Guide (732 KB) Updated April 2024276/277 Technical Update (97 KB) refreshed for next "as needed update"
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For HIPAA Information, please refer to the 'Frequently Asked HIPAA Questions' and continue to send in your questions to NJMMIS-HIPAA2@gainwelltechnologies.com |
