MedicaidCoverageMedium impact
Newsletter Vol. 7, No. 60
New Jersey Medicaid·NJ · Pediatrics·Medical Policy
Effective date
Nov 1, 1997
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid is limiting coverage of protein nutritional supplements and specialized infant formulas to a maximum 34-day supply per dispensing. Claims exceeding this quantity will be subject to retrospective review and recoupment. This policy is effective for claims with service dates on or after November 1, 1997.
Action Required
By November 1, 1997: Billing team must implement quantity controls in the billing system to ensure protein nutritional supplements and specialized infant formulas do not exceed a 34-day supply per claim. Update medical supply dispensing procedures and educate suppliers on the new limit. Review any paid claims already submitted for these items to confirm compliance; flag claims exceeding the 34-day supply for potential recoupment by New Jersey Medicaid. Contact the Chief, Pharmaceutical Services at (609) 588-2724 with any implementation questions. Note: Medicaid will conduct retrospective reviews of paid claims, and non-compliant claims will be subject to recoupment.