N.J. Admin. Code § 10:167A-1.24

Current through Register Vol. 57, No. 1, January 6, 2025

Section 10:167A-1.24 - Claim submission

(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.

Repeal and New Rule, R.1995 d.104, effective 2/21/1995.
See: 26 N.J.R. 4136(a), 27 N.J.R. 684(a).
Amended by R.1996 d.146, effective 3/18/1996 (operative April 1, 1996).
See: 27 N.J.R. 4566(a), 28 N.J.R. 1526(a).
Amended by R.1998 d.464, effective 9/8/1998.
See: 30 N.J.R. 2197(a), 30 N.J.R. 3309(a).
Recodified from N.J.A.C. 8:83C-1.22 by R.2003 d. 248, effective 6/16/2003.
See: 34 N.J.R. 3456(a), 35 N.J.R. 2642(a).
Former N.J.A.C. 8:83C-1.24, PAAD beneficiary identification, recodified to N.J.A.C. 8:83C-1.26.
Amended by R.2009 d.293, effective 10/5/2009.
See: 41 N.J.R. 1637(a), 41 N.J.R. 3804(a).

Amended by 49 N.J.R. 446(a), effective 3/6/2017