MedicaidAdministrativeHigh impact
Newsletter Vol. 15, No. 05
New Jersey Medicaid·NJ · Pharmacy·Provider Notice
Effective date
Jul 1, 2005
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid is implementing a Point-of-Sale Coordination of Benefits (POS-COB) process for pharmacy claims effective July 1, 2005. The State will now bill other available insurance coverage on behalf of pharmacies for claims originally paid by Medicaid, and will reduce pharmacy payments based on any recoveries from secondary insurance. Pharmacies must register with HMS before June 30, 2005 to participate.
Action Required
REQUIREMENTS:
- By June 30, 2005 (DEADLINE): All participating pharmacies must register with Health Management Systems, Inc. (HMS) at (877) 262-7375 to enroll in the POS-COB program. Pharmacies that do not register before the deadline will be subject to the new process without having access to required login credentials and tracking information.
- During registration: Provide HMS with (1) Medicaid Provider Number, (2) Provider Service Address, (3) Contact Information including email address, and (4) NCPDP provider identification number.
- Upon registration completion: Pharmacy staff must receive and securely store User ID and Password for HMS secure website (https://ecenter.hmsy.com) to track original State payments, secondary insurance PBM payments, and Medicaid rebill adjustments.
- Effective July 1, 2005: Billing team must monitor Remittance Advice (RA) statements for rebill transactions that reduce original claim payments (will appear in same week or following week of POS-COB transaction).
- Ongoing: Pharmacies must continue processing pharmacy claims through other insurance coverage when identified by the State's POS system and continue providing diagnostic information to First Health Services for PAAD Medicare Part B drug claim prior authorization processing.
- For questions: Contact HMS at (877) 262-7375 or Unisys Provider Services at (800) 776-6334.