Traditional MedicareDocumentationHigh impact
Senior Services News Vol. 5, No. 2
New Jersey Medicaid·NJ · Pharmacy, Geriatrics, Oncology +1 more·Pharmacy
Effective date
May 1, 2001
We identified it
Jun 20, 2026
Summary
Effective May 1, 2001, PAAD pharmacy providers must follow Medicare guidelines for Medicare-covered drugs (chemotherapy agents, immunosuppressive drugs, vaccines, bronchodilators, anti-emetics, and diabetic supplies). Pharmacists must obtain written prescriptions with diagnosis codes for all Medicare-covered drugs and may be contacted by PAAD to report diagnosis codes for retroactive Medicare billing. Initial prescriptions are limited to a 34-day supply.
Action Required
By May 15, 2001: All PAAD-participating pharmacies must sign and mail the enclosed EDI Enrollment Form to PAAD, P.O. Box 715, Trenton, NJ 08625-0715. Pharmacy staff must: (1) Request written prescriptions with diagnosis codes for all Medicare-covered drugs (chemotherapeutic agents, immunosuppressive drugs, pneumococcal/influenza/hepatitis vaccines, bronchodilators, oral anti-emetics for cancer chemotherapy, and diabetic supplies); (2) Refer to the Medicare Supplier Manual (call DMERC at 570-735-9445 or visit www.umd.nycpic.com/suppman.html) for dispensing guidelines; (3) Limit initial prescriptions to 34-day supply and request revised orders from physicians if greater quantities are requested; (4) Be prepared to receive calls from PAAD/First Health Services (877-888-2939) requesting diagnosis codes for retroactive Medicare processing. Chain store corporate offices may execute a single EDI form on behalf of all locations. Failure to comply with Medicare documentation requirements will result in claim denials and potential retroactive billing issues.