MedicaidPrior AuthHigh impact
Newsletter Vol. 2, No. 12
New Jersey Medicaid·NJ · Pharmacy·Provider Notice
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid is clarifying billing procedures for enteral nutritional products without National Drug Codes (NDC). Providers must now obtain prior authorization, use a hard copy MC Revised Prescription Claim Form, leave the NDC field blank, check the Compound Prescription Identification field, and include product name, manufacturer/distributor name, and package size in the designated field. Products without NDC numbers will be identified on remittance advice as Unlisted OTC Drugs.
Action Required
Immediately: Billing team must implement new procedures for enteral nutritional products without NDC numbers. Specifically: (1) Obtain prior authorization number and enter in Field on MC claim form before billing; (2) Complete hard copy MC Revised Prescription Claim Form per Fiscal Agent Billing Supplement; (3) Leave National Drug Code field (Field) completely blank—do not enter any numbers or letters; (4) Check the Compound Prescription Identification Field on the claim form; (5) Enter product name, manufacturer or distributor name, and package size in the designated field; (6) Route all such claims to Unisys Paramax CNT in Trenton, NJ. Update billing system to flag enteral nutritional products for manual review and prior authorization verification. Train billing staff on new form completion requirements. Claims submitted without prior authorization or with incorrect NDC field completion will be denied.