Traditional MedicareAdministrativeMedium impact
Senior Services News Vol. 27, No. 03
New Jersey Medicaid·NJ·Pharmacy
Effective date
Dec 1, 2024
We identified it
Jun 20, 2026
Summary
New Jersey's PAAD and Senior Gold pharmacy assistance programs have updated claims processing procedures, requiring specific billing order when Medicare Prescription Payment Plan is involved. Pharmacies must bill Medicare Part D primary, then PAAD/SG secondary, then to Medicare Prescription Payment Plan Bank to ensure correct patient responsibility amounts.
Action Required
Immediately: Pharmacy billing staff must update claims processing workflow to ensure proper billing sequence for PAAD/SG beneficiaries enrolled in Medicare Prescription Payment Plan. Bill Medicare Part D as primary, PAAD/SG as secondary, then Medicare Prescription Payment Plan Bank as tertiary. Use BIN=610515, PCN=PAAD for processing. Verify PAAD cards (yellow, ID starts with '6') and Senior Gold cards (white, ID starts with '7') are always billed secondary to primary insurance. Incorrect billing order will result in inaccurate patient responsibility amounts.