Newsletter Vol. 2, No. 45

Billing team must implement the following procedures for all Cystic Fibrosis Drug Program claims: (1) Verify patient eligibility by requesting the green laminated card issued by NJ State Department of Health and confirming the valid dates match the date of service; (2) Document the case number from the card (first four digits = program identifier, last two digits = record type, remaining digits = unique individual identifier); (3) Submit all pharmacy claims to ParamaxUnisys on MC pharmacy prescription claim forms, either hardcopy or electronically, following current Medicaid regulations and the Fiscal Agent Billing Supplement; (4) Before processing claims, verify that non-legend drug products are limited to only: antitussives, antihistamines, normal saline solutions, and vitamins essential for cystic fibrosis treatment—deny or reject claims for other non-legend drugs; (5) Ensure reimbursement is processed in accordance with New Jersey Medicaid's drug reimbursement policies. Update your billing system eligibility verification workflow and claims submission procedures to reflect these requirements. For questions about patient eligibility, contact the Nurse Consultant at Special Child Health Services; for pharmacy program questions, contact the Chief Pharmacy Consultant (contact numbers provided in policy).