MedicaidAdministrativeHigh impact
Newsletter Vol. 13, No. 72
New Jersey Medicaid·NJ · Pharmacy·Provider Notice
Effective date
Oct 22, 2003
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid is transitioning pharmacy remittance advice (RA) statements from the current Unisys format to the HIPAA 835 RA format. Effective immediately for claims with payment dates on or after October 22, 2003, pharmacies can opt into the new format; however, the old format will be discontinued entirely on or about January 1, 2004, at which point all electronic RAs will use only the HIPAA 835 format. Additionally, only HIPAA-approved error codes will appear on the new electronic statements, and claim submission formats are changing to NCPDP Version 5.1 and 1.1 for service dates on or after January 1, 2004.
Action Required
REQUIREMENTS:
- By January 1, 2004: Pharmacy billing team must ensure software and EDI systems are configured to accept and process the HIPAA 835 RA format. Contact Unisys EDI Unit (609-588-6051) if not ready to transition before the mandatory cutover date.
- Immediately: Verify with Unisys whether the practice is configured to receive the new HIPAA 835 RA format or confirm intention to continue current format until January 1, 2004.
- Before January 1, 2004: Update all pharmacy claim submission processes to use only NCPDP Version 5.1 and 1.1 (batch) claim formats for service dates on or after January 1, 2004. Discontinue use of NCPDP 3C Fixed format for these dates.
- Immediate: Obtain and reference Appendix F of the NCPDP Data Dictionary for the new HIPAA-approved error codes; Unisys error codes will no longer appear on electronic statements.
- Update software vendor and all staff receiving electronic remittance advice of the format change and implementation timeline.
Failure to transition to the new format by January 1, 2004, will result in inability to receive electronic remittance advice, and continued submission of deprecated claim formats may result in claim rejections.