NJMMIS Terms of Use and Licensing Agreement(s)

(All NJMMIS users must agree to these Terms to continue)

Combined Agreement for use of CPT and CDT codes

Current Procedural Terminology (“CPT”) codes, descriptions and other data only are copyright 2015 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association (AMA). Applicable FARS/DFARS apply.

Current Dental Terminology (“CDT” or CDTTM”) codes, nomenclature, descriptions and other data contained here are Copyright ©2015 American Dental Association (ADA). All rights reserved. Applicable FARS/DFARS apply. All rights reserved. CDT is a trademark of the ADA.

You, your employees, the organization you have the authority to represent and it employees and agents are authorized to use the CPT and CDT only as contained in the following authorized materials of the Center for Medicare and Medicaid Services (CMS) internally within your organization within the United States for the sole use by yourself, your employees, the organization you are authorized to represent and its employees and agents. Use is limited to use in Medicare, Medicaid and other programs administered by CMS. You agree to take all necessary steps to insure that you, your employees, organization and agents abide by the terms of this agreement. Any use not authorized herein is prohibited.

CPT and CDT are provided “as is” without warranty of any kind, either expressed or implied, including but not limited, the implied warranties of merchantability and fitness for a particular purpose.

The AMA, ADA and CMS disclaim responsibility for any consequences or liability attributable to or related to any use, non-use or interpretation of information contained or not contained in this product/file. This agreement will terminate upon notice if you violate the terms.

The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. By clicking the box “I agree”, you hereby acknowledge that you have read, understood and agreed to all terms and conditions set forth in this agreement. If acting on behalf of an organization you, you represent you have the authority to act on their behalf.

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Gainwell Technologies
  Provider Services
Click here for ICD 10 Resources.
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.
Click here for COVID-19 rates and codes.
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.html
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.
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" .
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.
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.
Important Information for Providers and Submitters about NPI Mapping 
Click here to access Important information regarding NPI mapping
Payment Error Rate Measurement (PERM) - Accessing Information
Click here to access information relating to Payment Error Rate Measurement (PERM) processing.
Payment Error Rate Measurement (PERM) - Important Information
Click here for important information regarding Payment Error Rate Measurement (PERM).
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.
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 (6505 KB) Upd September 2021
  • 837/835/277P Technical Update (102 KB) refreshed for next "as needed update" 
  • 5010 HIPAA 270/271 Companion Guide (1601 KB, for MEVS Switch Vendors only) Upd September 2021
  • 270/271 Technical Update (84 KB) refreshed for next  "as needed update" 
  • Pharmacy NCPDP D.0/1.2 Payer Sheet (1780 KB) Upd September 2021
  • NCPDP D.0/1.2 Technical Update (86 KB) refreshed for next "as needed update"
  • 5010 HMO Systems Guide (8340 KB) Upd September 2021  
  • HMO Encounters Technical Update (85 KB) refreshed for next "as needed update"
  • For HIPAA Information, please refer to the 'Frequently Asked HIPAA Questions' and continue to send in your questions to NJMMIS-HIPAA2@gainwelltechnologies.com