Newsletter Vol. 14, No. 56

By January 15, 2005 (URGENT - this deadline has long passed; if this practice still participates in NJ Medicaid pharmacy programs, immediate action is needed): Pharmacy providers must complete and return the Form FD-70 Pharmacy Provider Certification Statement with a copy of valid pharmacy permit to Unisys, P.O. Box 4804, Trenton, NJ 08650-4804. Billing/pharmacy leadership must: (1) Certify eligibility for each fee increment by answering all Section I questions accurately (impact allowance ≥50% state program prescription volume, 24-hour emergency service availability with local phone number, patient consultation/profile monitoring compliance); (2) Complete Section II ownership disclosure with all required partner/officer/stockholder information, degrees, home addresses, and ownership percentages; (3) Ensure ALL form fields are completed or form will be returned; (4) Attach copy of current valid pharmacy permit. If form is not received by January 15, 2005, the State will automatically assign only base dispensing fee without any increments, reducing reimbursement. If circumstances change (impact allowance threshold drops below 50%, 24-hour service discontinued), notify Unisys in writing within 30 days (72 hours for service discontinuation) or face state recovery of overpaid increments retroactive to certification date. Retain newsletter numerically behind blue Tab 5 for compliance records.