MedicaidBilling CodesHigh impact
Medicaid Alert MA2018-02
New Jersey Medicaid·NJ · Pharmacy·Provider Notice
Effective date
Jun 1, 2018
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid is implementing mandatory NCPDP D.0/1.2 standards for pharmaceutical claims. Five specific data fields must be validated and submitted correctly, or claims will be denied starting June 1, 2018. Billing teams must ensure pharmacy claim submission software complies with these NCPDP standards for Compound Code, Compound Dosage Form, Ingredient Cost, Gross Amount Due, and Patient Residence fields.
Action Required
By May 31, 2018: Pharmacy billing team must validate and update all pharmacy claim submission software to ensure compliance with five mandatory NCPDP D.0/1.2 data field requirements: (1) Compound Code (406-D6) must be 1 or 2; (2) Compound Dosage Form Description Code (450-EF) must be 01-18, right-justified and zero-filled; (3) Ingredient Cost Submitted (409-D9) must be greater than zero; (4) Gross Amount Due (430-DU) must be greater than zero; (5) Patient Residence (384-4X) must be 00-15. Test all claim submissions in staging environment before June 1, 2018. Communicate validation requirements to all pharmacy providers submitting claims to New Jersey Medicaid. After June 1, 2018, claims not meeting these standards will be denied. Contact Molina Medicaid Solutions Provider Services at 1-800-776-6334 with questions.