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New Jersey MedicaidMedicaid · Administrative · Provider Notice · NJ · PharmacyHigh impact

Newsletter Vol. 14, No. 02

Act
by Jan 21, 2004
Effective date
Jan 21, 2004
Identified
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.

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What to do

by Jan 21, 2004 · 5 steps
01Billing 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.
02Contact Unisys and billing software vendor to confirm system compliance.
03Test submission of sample claims in the new format before the deadline.
04By 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.
05Pharmacy providers and billing staff should contact DMAHS Office of Information Systems at (609) 588-2450 for testing opportunities and technical support.
If missed: Failure to update claim formats will result in claim denials and payment delays for all New Jersey Medicaid pharmacy claims.

Original notice

Newsletter Vol. 14, No. 02
njmmis.com · Always check the source before changing claims.
View original ↗

Related changes

See all New Jersey Medicaid changes →
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