Balance Billing Under NJ Medicaid

Can a provider bill a beneficiary for all or part of the difference between the provider’s charged fees and the payment received from NJ Medicaid or a managed care plan? The NJ Department of Human Services, Division of Medical Assistance & Health Services (Department) recently answered that question.

Balance billing, says the Department, is prohibited under state and federal law and this prohibition applies to FFS services as well as services rendered under a managed care arrangement.

The Department’s requirements, similar to that of the NYS Medicaid, is that a provider enrolled in the NJ Medicaid/NJFC FFS or a managed care program is required to accept as payment in full the reimbursement fees paid by such programs. Beneficiaries are not permitted to be billed for any additional charges except for those cost sharing responsibilities specifically authorized by law.

If you have a question about NJ Medicaid, program enrollment, participation or revalidation, please contact our office.