MedicaidCoverageMedium impact
Newsletter Vol. 7, No. 47
New Jersey Medicaid·NJ · Pharmacy·Provider Notice
Effective date
Aug 1, 1997
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid established a 'Good Faith Payment' process for DYFS (Division of Youth and Family Services) beneficiaries whose pharmacy claims are initially denied due to eligibility file delays in the POS/PDUR system. Pharmacists must dispense medications when a valid DYFS Eligibility Identification Card is presented, and pharmacies can request reimbursement by submitting hard-copy MC-6 claim forms with the card copy and 'Good Faith Payment' notation in Field 18.
Action Required
Immediately: Pharmacy staff must implement the following Good Faith Payment procedure: (1) When POS/PDUR system denies a claim for a DYFS beneficiary who presents a valid DYFS Eligibility Identification Card (beneficiary ID format: positions 1-2 are '01'-'21', positions 3-4 are '60'), dispense the prescribed medication. (2) Billing team must prepare hard-copy pharmacy claim forms (MC-6) with a copy of the DYFS Eligibility Identification Card attached. (3) In Field No. 18 of the MC-6 form, enter 'Good Faith Payment' and submit to Unisys at P.O. Box 4801, Trenton, NJ 08650-4801. (4) Train all pharmacy staff to recognize valid DYFS ID cards and document Good Faith Payment claims appropriately. Failure to follow this process will result in denied claims for otherwise eligible DYFS beneficiaries. Contact Unisys Provider Services at 1-800-776-6334 for questions.