New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 167A - PROVISION OF PHARMACEUTICAL SERVICES UNDER THE PHARMACEUTICAL ASSISTANCE TO THE AGED AND DISABLED PROGRAM (PAAD)
Subchapter 1 - REQUIREMENTS FOR PROVISION OF PHARMACEUTICAL SERVICES
Section 10:167A-1.24 - Claim submission
Universal Citation: NJ Admin Code 10:167A-1.24
Current through Register Vol. 56, No. 6, March 18, 2024
(a) An approved pharmacy provider shall enter into an agreement with a point-of-sale (POS) intermediary in accordance with the requirements of N.J.A.C. 10:167A-1.27 or directly provide a similar telecommunication network approved by DMAHS to submit claims to the fiscal agent for adjudication. POS claims require an electronic format, which complies with the EMC National Council Prescription Drug Program standards.
1. The approved POS intermediary or provider established network shall enter into an agreement with the State of New Jersey to provide on-line telecommunication services, including transmission of pharmacy claim detail data, access to the fiscal agent's POS computer and return of adjudicated claim data to the provider.
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