MedicaidAdministrativeHigh impact
Newsletter Vol. 16, No. 14
New Jersey Medicaid·NJ · Pharmacy·Pharmacy
Effective date
Nov 21, 2006
We identified it
Jun 20, 2026
Summary
New Jersey is implementing the final transition phase for dual-eligible beneficiaries (Medicare + Medicaid) to receive prescription drug coverage through Medicare Part D instead of Medicaid. Starting November 21, 2006, pharmacy claims for Part D-covered drugs will be denied with Error Code 2043 if the beneficiary is determined eligible for Medicare Part D. Pharmacies must verify PDP enrollment and submit claims to Anthem if no enrollment is found, requiring both Medicare HICN and Medicaid ID numbers.
Action Required
By November 21, 2006: Pharmacy billing team must implement the following procedures: (1) Train all pharmacy staff to recognize Error Code 2043 denials and understand they indicate dual Medicare/Medicaid eligibility; (2) When a claim is denied with Error Code 2043, submit an E1 query to verify Part D enrollment status; (3) If E1 query returns 'no match,' immediately submit the claim to Anthem for Part D enrollment facilitation and claim processing; (4) Update billing software to capture and submit BOTH the Medicare HICN (Health Insurance Claim Number) AND Medicaid ID number on all pharmacy claims for dual-eligible clients—both numbers are critical for verification; (5) Continue processing Medicaid claims for Part D-excluded drugs (benzodiazepines, barbiturates, certain vitamins) through NJ FamilyCare/Medicaid as before. Contact Anthem Pharmacy Help Desk at (800) 662-0210 for assistance or NJ FamilyCare/Medicaid Hotline at 1-800-356-1561 for questions. Failure to implement these procedures will result in continued claim denials and potential enrollment delays for dually-eligible beneficiaries.