MedicaidPrior AuthHigh impact
Newsletter Vol. 10, No. 16
New Jersey Medicaid·NJ · Pharmacy·Prior Authorization
Effective date
Mar 1, 2000
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid is expanding prior authorization (PA) requirements for specific pharmaceutical services to Camden City WFNJ/GA beneficiaries, effective March 1, 2000. Pharmacies must obtain PA approval before dispensing listed drugs and related products (including refills), with a 72-hour emergency supply exception. Beneficiaries are identified by eligibility IDs beginning with '5748'.
Action Required
By February 29, 2000: Pharmacy billing team must obtain and review the complete list of drugs requiring prior authorization (referenced but not detailed in this newsletter excerpt). Establish workflow to contact WFNJ/GA PA Unit at 1-800-609-0106 (8:30 A.M.–4:30 P.M. weekdays) before dispensing any listed drugs to beneficiaries with IDs starting with '5748'. For after-hours emergencies only: dispense 72-hour supply and submit original hard-copy claim to Unisys (P.O. Box 4807, Trenton, NJ 08650-4807) with 'Emergency' marked in field 18 of MC-6 form. All non-emergency prescriptions must be held until next business day when PA Unit is available. Failure to obtain prior authorization will result in claim denials. Train all pharmacy staff on new procedures and verify system can identify qualifying beneficiaries by ID prefix '5748'.