MedicaidAdministrativeHigh impact
Newsletter Vol. 14, No. 02
New Jersey Medicaid·NJ · Pharmacy·Provider Notice
Effective date
Jan 21, 2004
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid (DMAHS) is discontinuing acceptance of legacy NCPDP Version 3C and proprietary Unisys claim formats for electronic pharmacy claims. Starting January 21, 2004 for POS claims and April 1, 2004 for EMC claims, only NCPDP Version 5.1 (POS) and Version 1.1 (EMC) formats will be accepted. Claims submitted in old formats will be denied payment.
Action Required
By January 21, 2004: Billing team and IT must verify that all electronic pharmacy claim submission systems are configured to generate NCPDP Version 5.1 format for point-of-sale (POS) claims. Contact Unisys and billing software vendor to confirm system compliance. Test submission of sample claims in the new format before the deadline. By April 1, 2004: For Electronic Medium Claims (EMC) submitters, update systems to use NCPDP Version 1.1 format; EMC claims submitted in Unisys proprietary format after this date will be denied payment. Pharmacy providers and billing staff should contact DMAHS Office of Information Systems at (609) 588-2450 for testing opportunities and technical support. Failure to update claim formats will result in claim denials and payment delays for all New Jersey Medicaid pharmacy claims.