Coverage profile
Work Medicare New Jersey Part B across every published route
Use the current payer record to choose the right claim-status, eligibility, portal, phone, or appeals workflow. Substrate only marks routes that are published for this payer.
Eligibility
EDI 270/271The Substrate Eligibility Agent can verify patient benefits, identify TPAs and carve-outs, and more with Medicare New Jersey Part B.
Portal claim status
Browser automationThe Substrate Claim Status Agent can check claim status via the payer portal for Medicare New Jersey Part B.
Other aliases
Also known as
- 12402
- 1465
- NJMCR
- SMNJ0
- Novitas - New Jersey
- MEDICARE
Payer intelligence
Observed adjudication timing
How long completed claims in Substrate’s aggregate network took from payer receipt to the 835 payment date.
Median time to payment
7.8 days- 10% of adjudications by
- 2 days
- 90% of adjudications by
- 14 days
- Applicable state coverage
- PA
- Current As Of
- July 2026
Five-month median trend
Days to 835 paymentView chart data as a table
| Service month | Median | 10% of adjudications by | 90% of adjudications by | Completed claims | Coverage |
|---|---|---|---|---|---|
| Apr | No qualified data | ||||
| May | 14 days | 2 days | 14 days | 222 | PA |
| Jun | 8 days | 2 days | 14 days | 233 | PA |
| Jul | 7.8 days | 2 days | 14 days | 273 | PA |
| Aug | No qualified data | ||||
2027 maternity billing research
When does Medicare New Jersey Part B change OB/GYN billing?
For CY 2027, CMS proposes revised maternity CPT work RVUs and seeks comment on creating 15 alternative HCPCS G-codes that would preserve the previous MMM global structure for Medicare PFS payment instead of adopting the new CPT codes. These are proposed alternatives, not finalized billing instructions.
- Transition start
- CY 2027 proposal; operational transition date not established
- Billing start
- Not specified in supplied text
- Published
- 2026-07-16
- Current As Of
- August 2026
Scope: Federal Medicare Part B/PFS maternity medical services only; not dental-product guidance or New Jersey-specific MAC implementation instructions.
CY 2027 Physician Fee Schedule proposed rule. Verify the payer source before claim submission.
Frequently asked questions
Medicare New Jersey Part B payer FAQs
Can I automate Medicare New Jersey Part B portal follow-up?
Yes — portal retrieval is required when 276/277 is missing or stale. See payer portal automation and learn why 276/277 is not enough.
What is the payer ID for Medicare New Jersey Part B?
The primary payer ID for Medicare New Jersey Part B is 12402. The correct routing ID can differ by clearinghouse and transaction, so compare the 837P, 837I, 835, 270, and 276 entries before submitting.
What is the provider portal for Medicare New Jersey Part B?
The provider portal for Medicare New Jersey Part B is https://www.novitasphere.com. Available features depend on the payer and your account.
What is the 837P payer ID for Medicare New Jersey Part B?
The 837P payer ID for Medicare New Jersey Part B is 12402 via Stedi.
What is the 835 payer ID for Medicare New Jersey Part B?
The 835 payer ID for Medicare New Jersey Part B is 12402 via Stedi.
What is the 270 payer ID for Medicare New Jersey Part B?
The 270 payer ID for Medicare New Jersey Part B is 12402 via Stedi.
What state does Medicare New Jersey Part B operate in?
Medicare New Jersey Part B operates in NJ.
Routing reference
Medicare New Jersey Part B payer IDs and operating states
Use the payer ID listed for the transaction you are submitting. Verify current routing and enrollment requirements with your clearinghouse.
| Payer name | Medicare New Jersey Part BSource: Substrate payer directory · data last changed |
|---|---|
| Operating states | NJSource: Substrate payer directory · data last changed |
| 837P professional claims payer IDStedi | 12402Enrollment requiredSource: Stedi payer catalog · catalog dated · matched by payer ID |
| 835 ERA payer IDStedi | 12402Enrollment requiredSource: Stedi payer catalog · catalog dated · matched by payer ID |
| 270 eligibility payer IDStedi | 12402Enrollment requiredSource: Stedi payer catalog · catalog dated · matched by payer ID |
Routing sources and verification
- Substrate payer directoryPayer identity, aliases, operating states, and vendor IDs. Data last changed ; checked .Open payer website ↗
- Stedi payer catalogMatched by payer ID; matched record: Medicare New Jersey Part B. Source dated .PrimaryPayerId is used as the transaction payer ID when the corresponding Stedi support flag is true.Open current Stedi reference ↗
Clearinghouse payer IDs are transaction-specific and can change. Confirm the current payer list and the member’s ID card before submission.
Payer contact directory
Medicare New Jersey Part B phone and fax numbers
Use the number associated with your task. These contacts were stated in successful eligibility responses and may apply to specific benefits, products, or departments.
- Eligibility / benefits phone
- (551) 225-2014CLOVER INSURANCE COMPANY
| Channel and number | Payer Notes | Department | Specialties |
|---|---|---|---|
| phone(551) 225-2014 | Eligibility / benefits, PharmacyBenefit context: Contact Following Entity for Eligibility or Benefit Information; Benefit context: Other or Additional Payor |
| Health Benefit Plan Coverage, Pharmacy |
| phone(614) 572-7033 | Eligibility / benefits, PharmacyBenefit context: Contact Following Entity for Eligibility or Benefit Information; Benefit context: Other or Additional Payor |
| Health Benefit Plan Coverage, Pharmacy |
| phone(800) 448-6262 | Eligibility / benefits, PharmacyBenefit context: Contact Following Entity for Eligibility or Benefit Information; Benefit context: Other or Additional Payor |
| Health Benefit Plan Coverage, Pharmacy |
| phone(800) 643-4845 | Eligibility / benefits, PharmacyBenefit context: Contact Following Entity for Eligibility or Benefit Information; Benefit context: Other or Additional Payor |
| Health Benefit Plan Coverage, Pharmacy |
| phone(973) 466-5503 | Eligibility / benefits, PharmacyBenefit context: Contact Following Entity for Eligibility or Benefit Information; Benefit context: Other or Additional Payor |
| Health Benefit Plan Coverage, Pharmacy |
| phone(202) 942-1270 | PharmacyBenefit context: Other or Additional Payor |
| Pharmacy |
| phone(423) 954-6977 | PharmacyBenefit context: Other or Additional Payor |
| Pharmacy |
| phone(866) 235-5660 | PharmacyBenefit context: Other or Additional Payor |
| Pharmacy |
| phone(866) 460-8854 | PharmacyBenefit context: Other or Additional Payor |
| Pharmacy |
| phone(888) 888-9355 | PharmacyBenefit context: Other or Additional Payor |
| Pharmacy |
Phone and fax numbers sourced directly from the payer response