MedicaidPrior AuthHigh impact
Newsletter Vol. 9, No. 69
New Jersey Medicaid·NJ · Pharmacy, Pediatrics, Psychiatry·Prior Authorization
Effective date
Dec 1, 1999
We identified it
Jun 20, 2026
Summary
Effective December 1, 1999, New Jersey Medicaid is transferring prior authorization (PA) processing for ADD drugs, methadone, protein nutritional supplements, and specialized infant formulas from Medicaid District Offices (MDOs) to First Health Services Corporation (the MEP contractor). Pharmacies must now contact First Health Services at 1-877-888-2939 to request PA for these products; the PA process will be triggered by Edit 535 in the point-of-sale claims system.
Action Required
By November 30, 1999: (1) Pharmacy staff must stop submitting PA requests to Medicaid District Offices for ADD drugs, methadone, protein nutritional supplements, and specialized infant formulas. (2) Update all internal PA request procedures to direct pharmacy staff to contact First Health Services Corporation at 1-877-888-2939 (24/7) instead of MDOs. (3) Train pharmacy staff to recognize Edit 535 in the point-of-sale claims system as the trigger for PA requirements. (4) Update pharmacy workflow to allow pharmacists to request PA through First Health Services and expect PA number availability within 1 hour for non-emergency requests before 5 P.M. (5) Communicate emergency dispensing protocol to pharmacy staff: up to 6-day emergency supply may be dispensed without PA if beneficiary is out of medication; PA will be required for additional supply after emergency period. (6) Update patient and provider contact information resources to reference First Health Services at 1-877-888-2939 for PA inquiries and 1-877-266-3589 for physician/beneficiary inquiries. Failure to obtain PA from the correct contractor will result in claim denials and delayed reimbursement.