MedicaidAdministrativeHigh impact
Newsletter Vol. 26, No. 07
New Jersey Medicaid·NJ · Pharmacy·Eligibility
Effective date
Aug 15, 2016
We identified it
Jun 20, 2026
Summary
NJ FamilyCare (NJFC) Fee-for-Service program is terminating participation for pharmacies and prescribers who failed to complete re-enrollment by specified deadlines (August 15, 2016 for pharmacies; July 11, 2016 for prescribers). A 15-day grace period exists for beneficiaries to fill medications from non-re-enrolled prescribers, with specific error codes denoting claim status. Billing teams must track prescriber enrollment status and apply appropriate denial codes or prior authorization.
Action Required
REQUIREMENTS:
- By August 15, 2016: Billing team must verify that all NJ FamilyCare FFS pharmacy providers are re-enrolled in the program. Any pharmacy claims from non-re-enrolled providers will receive Error Code 0696 and be denied. Contact Molina Medicaid Solutions at 1-800-776-6334 to confirm enrollment status.
- Effective immediately (from July 11, 2016): Billing team must implement error code tracking for prescriber claims:
* Error Code 2266 = Ineligible prescriber (15-day grace period begins)
* Error Code 2267 = DS limit exceeded for grace period
* Error Code 2268 = RX filled within 15-day grace period (allowed)
* Error Code 2269 = Ineligible prescriber outside grace period (no fills allowed)
- For claims denied with Error Code 2266: Billing team or pharmacy may resubmit once during the 15-day grace period for up to a 30-day supply. Educate providers to contact Molina at 1-800-776-6334 to complete re-enrollment or request non-billing provider status (FD-20 or FD-20B applications).
- For quantities exceeding 30 days or prescriptions outside the grace period: Pharmacy or prescriber must request prior authorization from Molina Medical Exception Process (MEP) Unit at 1-877-888-2939 documenting medical necessity.
- Failure to process claims correctly will result in claim denials and potential coverage gaps for beneficiaries.