MedicaidPrior AuthHigh impact
Newsletter Vol. 10, No. 45
New Jersey Medicaid·NJ · Pharmacy·Provider Notice
Effective date
Jun 15, 2000
We identified it
Jun 20, 2026
Summary
New Jersey's PAAD program is implementing Prospective Drug Utilization Review (PDUR) monitoring based on duration of therapy standards for specified medications effective June 15, 2000. Pharmacists will receive Error Code 403 when duration limits are exceeded and must contact First Health Services for prior authorization. Claims exceeding duration periods will be denied with Error Code 404, requiring resubmission with adjusted quantities.
Action Required
By June 15, 2000: Pharmacy billing team must configure point-of-sale (POS) billing system to enforce Error Code 403 (Dosage Duration Exceeded) and Error Code 404 (Duration Standard Exceeded-Possible Cutback) for all PAAD claims matching the Therapy Duration Table. Implement workflow to: (1) flag claims exceeding duration standards listed in table for medications including cimetidine, famotidine, lansoprazole, nizatidine, omeprazole, and ranitidine at specified dosages; (2) route Error Code 403 claims to pharmacist for prior authorization contact with First Health Services at (877) 888-2939; (3) auto-deny claims with Error Code 404 showing remaining days available for resubmission. Train pharmacy staff on new denial codes and resubmission process. Update PAAD claim submission procedures to reflect 90-day duration limits and non-covered intervals per attached table. Failure to implement will result in improper claim payments and potential audit findings.