Audit Process

The State of New Jersey will perform pre- and post-payment monitoring to ensure that incentive payments are paid in accordance with all Federal and State regulations and policies. Providers should keep all documentation supporting attestation for 6 years in the event of an audit.

Pre-Payment Audit and Monitoring

Prior to issuing payment, all attestations will be reviewed based on information provided through the New Jersey Medicaid Promoting Interoperability Program Attestation Application. These reviews will include electronic inquiries and manual reviews using available data sources such as the provider’s claims and encounter data stored in the New Jersey Medicaid Management Information System (MMIS) as well as other State databases and registries.

Pre-payment checks will be made to verify the following:

  • The provider is enrolled in New Jersey Medicaid.
  • The provider is licensed and was licensed for the applicable time frame with no suspensions or revocations (including pharmaceutical prescribing licensure).
  • The provider is not deceased.
  • The provider has not been sanctioned
  • The provider’s Tax Identification Number (TIN) has been verified by matching with an IRS TIN
  • The minimum patient volume threshold is achieved from a check of claims volume and the supporting information submitted.
  • No previous year payment was made, for providers claiming incentives based on adoption, implementation, or upgrading (AIU) or meaningful use of EHR technology.
  • The provider successfully met the requirements of adopting, implementing or upgrading (AIU) to or meaningful use (MU) of certified EHR technology.

The federal government will perform additional pre-payment checks once the State has accepted a provider's attestation.

Post-Payment Audit and Monitoring

After the payment is issued, recipients will be selected for onsite inspection of the documentation supporting their original attestations and other eligibility criteria.  Original documentation to be tested will include, but not be limited to, the documents that support the patient encounter data and attestation data that support the adoption, implementation or upgrading to a and meaningful use of certified EHR technology.  Representatives from the State contracted auditors, Mercadien P.C. Certified Public Accountants, will perform these onsite inspections and report any findings to the New Jersey Division of Medical Assistance and Health Services.

Correcting Overpayments

If an audit determines that an error in payment has been made, a written notification will be created and sent, informing the provider of the intent to recover funds.  The recovery process will follow current New Jersey Division of Medical Assistance and Health Services recovery practices and guidelines.

Last Reviewed: 5/9/2018