MedicaidAdministrativeHigh impact
Medicaid Alert MA2020-05
New Jersey Medicaid·NJ · Pharmacy·Pharmacy
Effective date
Sep 20, 2020
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid is implementing enhanced NCPDP telecommunication standards for pharmacy claims effective September 20, 2020. Providers must now capture and validate the quantity prescribed (460-ET field), dispensing status (343-HD), fill numbers (403-D3), prescription written dates (414-DE), and refill authorizations (415-DF) on all prescriptions. Claims will be denied if these fields are missing, incorrect, or fail new edits for Schedule II drug partial fills and prescription expiration limits (30 days for controlled drugs, 365 days for non-controlled drugs).
Action Required
By September 20, 2020: Billing team and pharmacy software vendors must implement the following changes: (1) Update Point-of-Sale (POS) systems to capture and validate NCPDP 460-ET (Quantity Prescribed), 343-HD (Dispensing Status), 403-D3 (Fill Number), 414-DE (Date Prescription Written), 415-DF (Number of Refills Authorized), and 442-E7 (Quantity Filled) fields on all pharmacy claims submitted to New Jersey Medicaid; (2) Configure system edits to enforce the error codes specified in the policy table (Error Codes 2331-2341, ET, 17, 28, 29, E7) to prevent claim submission or flag claims before transmission; (3) Ensure Schedule II drug claims validate that partial fills have quantity intended greater than quantity dispensed, quantity dispensed does not exceed quantity prescribed, and fill numbers are zero; (4) Ensure all controlled drug prescriptions have written dates within 30 days of claim date of service; ensure non-controlled drugs have written dates within 365 days; (5) Train pharmacy staff and billing personnel on new requirements; (6) Download and review updated NCPDP D.0/1.2 Payer Sheet and HMO Encounter Systems Guide (Version 5010) from www.njmmis.com under 'Forms and Documents.' Failure to implement these edits will result in claim denials with error codes 2331-2341, ET, 17, 28, 29, and E7.