MedicaidAdministrativeHigh impact
Newsletter Vol. 18, No. 05
New Jersey Medicaid·NJ · Pharmacy·Provider Notice
Effective date
May 23, 2008
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid, PAAD, and Senior Gold pharmacy providers must now report the National Provider Identifier (NPI) for both the pharmacy and prescribing provider on all electronic pharmacy claims submitted on or after May 23, 2008. Pharmacy claims without proper NPI reporting in the correct NCPDP format segments will be rejected and denied for payment.
Action Required
By May 23, 2008: Pharmacy billing team must ensure all electronic pharmacy claims submitted via NCPDP Version 5.1 or Version 1.1 Batch Standard include the pharmacy NPI in the Service Provider ID field with Qualifier value '01', and the prescribing provider identifier (either NPI with Qualifier '01' or New Jersey State License Number with Qualifier '08') in the Prescriber Segment. Verify the 10-digit NPI is numeric and valid. Register NPI with Unisys Provider Enrollment (609-588-6074) if not already done. Update pharmacy billing software to enforce these requirements and reject claims missing proper NPI coding. Paper claims must continue to report NJFC/Medicaid Provider Numbers. Failure to comply will result in claim denials. Contact Unisys Provider Services at 1-800-776-6334 with questions.