Prepayment and Post-Payment
After the payment is issued, recipients will be selected for onsite inspection of the documentation supporting their original attestations and other eligibility criteria.
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.
The appeals process will allow providers 20 days from a formal notice of agency action to request a hearing on their complaint. The hearings will be conducted by an Administrative Law Judge from the New Jersey Office of Administrative Law and conducted pursuant to this Office’s regulatory procedures with prompt, definitive, and final administrative action to be taken within 90 days from the hearing date. Providers will receive a written final decision from the Department and will have the right to pursue additional judicial review of this decision.
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