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New Jersey MedicaidMedicaid · Prior Auth · Prior Authorization · NJ · PharmacyHigh impact

Newsletter Vol. 9, No. 02

Act
by Dec 31, 1998
Effective date
Jan 1, 1999
Identified
Jun 20, 2026

Summary

New Jersey's Newark and East Orange General Assistance programs are expanding prior authorization (PA) requirements to additional pharmaceutical drugs and entire therapeutic drug classes, effective January 1, 1999. Pharmacies must obtain PA from the DFD PA Unit (1-800-609-0106) for these newly covered drugs during business hours 8:30 A.M. to 4:30 P.M., Monday through Friday. A revised complete list of drugs requiring PA is attached to this newsletter.

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What to do

by Dec 31, 1998 · 6 steps
01Pharmacy billing team and providers must obtain and review the attached revised drug list identifying which pharmaceuticals now require prior authorization.
02Update billing system, pharmacy software, and internal procedures to flag all newly added drugs and therapeutic drug classes for PA requirement before processing claims.
03Train all pharmacy staff and billing personnel on the expanded PA requirements.
04Beginning January 1, 1999: All claims for service dates on or after this date must include prior authorization before submission.
05Implement workflow to route newly covered drugs through PA process with DFD PA Unit.
06Contact DFD PA hotline at 1-800-609-0106 with questions.
If missed: Failure to obtain prior authorization for expanded drug classes will result in claim denials.

Original notice

Newsletter Vol. 9, No. 02
njmmis.com · Always check the source before changing claims.
View original ↗

Related changes

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