MedicaidAdministrativeHigh impact
Newsletter Vol. 22, No.06
New Jersey Medicaid·NJ · Pharmacy·Medical Policy
Effective date
May 1, 2012
We identified it
Jun 20, 2026
Summary
New Jersey's Medicaid pharmacy program is mandating NCPDP D.0/1.2 pharmacy claim transactions effective May 1, 2012, and will deny all NCPDP 5.1/1.1 transactions. Additionally, all pharmacy claims must include Benefit Stage Amount fields for Medicare Part D beneficiaries, or claims will be denied with Error Code 2236.
Action Required
By May 1, 2012: (1) Billing team and software vendors must ensure all pharmacy claim submissions to Molina Medicaid Solutions (BIN 610515) use NCPDP D.0/1.2 transaction format only. Update billing software to reject or convert any NCPDP 5.1/1.1 transactions. (2) For all Medicare Part D claims, ensure the Benefit Stage Amount field is populated on every claim submission with the appropriate benefit stage (deductible, initial, donut hole, or catastrophic). Claims without this field will be denied with Error Code 2236. (3) Contact Molina Medicaid Solutions EDI Unit at 609-588-6051 if certification issues occur. (4) Notify software vendors of updated testing hours (Tuesday-Friday, 9 AM-3 PM). Failure to comply will result in claim denials and payment suspension for non-compliant pharmacies.