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Fill out Medicaid Form FD-70, Pharmacy Provider Certification Statement Participating Medicaid/NJ Family Care pharmacy providers and, on behalf of the Department of Health and Senior Services (DHSS), PAAD, Senior Gold, ADDP, and CF pharmacy providers, must submit information annually to DMAHS in order to obtain optional increments in addition to the basic dispensing fee. To qualify for these optional increments to the basic dispensing fee, information relevant to 24-hour emergency service, patient consultation, and impact allowance is required. This information is used to determine appropriate dispensing fees for pharmacy claims submitted to the State for payment consideration, as described in NJAC 10:51-1.7 and 8:83C-1. Pharmacy providers must complete and return the Pharmacy Provider Certification Statement and attach a copy of its valid pharmacy permit no later than December 15, 2006. Please forward the documents to: Unisys P.O. Box 4804 Trenton, NJ 08650-4804 Attn: Form FD-70 NOTE: If any pharmacy provider fails to complete and return the Pharmacy Provider Certification Statement by December 15, 2006, the State will automatically assign the b asic dispensing fee, without the optional increments, to that pharmacy. NO changes to the assigned basic dispensing fee will become effective until a properly completed Pharmacy Provider Certification Statement, including a copy of the the pharmacy's valid pharmacy permit, is received by Unisys.
Final Transition Phase for Medicare Part D Prescription Drug coverage for Dual-Eligible Beneficiaries Effective for claims with service dates on or after November 21, 2006 Error code 2043 "Recipient Eligible for Medicare Part D" will accompany a denial of payment of pharmacy claims for Medicare Part D covered drugs when a Medicaid beneficiary is determined eligible for Medicare If the beneficiary presents at the pharmacy with a Medicaid card and the claim was denied for Error Code 2043, the pharmacy should send an E1 Query to determine Part D enrollment. If the E1 Query returns a "no match" response the pharmacy should submit the claim to Anthem). This will allow the prescription to be filled and will begin the process of enrolling the dually-eligible client in a Part D plan. Pharmacists will have to submit the client's Medicare ID number (known as the HICN), as well as the Medicaid ID number. Both numbers are critical to rapid verification of dual eligibility. The Anthem Prescription Pharmacy Help Desk may be contacted at 800-662-0210 to request further assistance. NJ Family Care/Medicaid will continue to process claims for drugs excluded from Part D Plans; for example, benzodiazepines, barbiturates, and certain vitamins. If Providers have any questions, they may contact the NJ Family Care/Medicaid Hotline at 1-800-356-1561
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