MedicaidAdministrativeHigh impact
Medicaid Alert MA2019-02
New Jersey Medicaid·NJ · Pharmacy·Provider Notice
Effective date
May 1, 2019
We identified it
Jun 20, 2026
Summary
Effective May 1, 2019, New Jersey Medicaid requires that pharmacy claims report only Type 1 NPIs (individual practitioner identifiers) for prescribers, not Type 2 NPIs (group/facility identifiers). Pharmacy claims submitted with Type 2 NPIs will be denied with Error Code 2298. Billing teams must verify prescriber NPIs are Type 1 entities before claim submission.
Action Required
By April 30, 2019: Billing team must implement NPI validation in the pharmacy claims submission process to ensure all prescriber NPIs are Type 1 Entity Types (individual practitioners) and reject or correct any Type 2 NPIs (group/facility entities) before submission. Update claim scrubbing logic and provider master files to flag Type 2 prescriber NPIs. Train pharmacy billing staff to verify prescriber NPI type matches NPPES records. Notify all prescribing providers to verify their individual NPI is on file with the practice. Failure to submit Type 1 NPIs will result in claim denials with Error Code 2298.