MedicaidAdministrativeHigh impact
Newsletter Vol. 10, No. 04
New Jersey Medicaid·NJ · Pharmacy·Pharmacy
Effective date
Jan 15, 2000
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid is implementing two pharmacy policy changes effective January 15, 2000: (1) reducing the Monthly Prescription Volume Threshold Process (MPTP) limit from 12 to 10 prescriptions per calendar month, and (2) activating maximum daily dosage edits (Edit 535) for pharmaceutical inhalers with a Medical Exception Process (MEP) available for overrides.
Action Required
By January 15, 2000: (1) Billing team must update pharmacy claims processing system to enforce the new 10-prescription monthly threshold for MPTP instead of the current 12-prescription limit. (2) Pharmacy staff must configure Edit 535 activation for all pharmaceutical inhaler claims to enforce maximum daily dosage standards per DMAHS/DHSS Newsletter Volume 9, No. 11 (August 1999). (3) Establish MEP submission procedures for inhaler claims exceeding daily limits—contact First Health Services (1-877-888-2939) for MEP procedures or DMAHS Pharmaceutical Services Chief (609-588-2724) for policy questions. Claims submitted on or after January 15, 2000 without compliance will be subject to threshold rejections and daily dosage edits. Retain this newsletter for reference behind the Blue Tab marked "5".