ContractOctober 24th, 2018
All New Jersey Medicaid and other state benefit program pharmacy providers desiring to submit NCPDP D.0 or 1.2 HIPAA formatted electronic claims must complete a New Jersey EDI Agreement as part of the trading partner agreement as required by HIPAA guidelines.
AUTHORIZATION AGREEMENT FOR AUTOMATIC PAYMENTS/DEPOSITSAuthorization Agreement • March 10th, 2021
Electronic Remittance Advice (ERA) EDI Agreement (Form EDI-801)Electronic Remittance Advice • October 24th, 2018
All New Jersey Medicaid and Charity Care Providers desiring to receive a HIPAA formatted electronic remittance advice (ERA) must complete a New Jersey Medicaid Electronic Remittance Advice EDI Agreement. The New Jersey Medicaid HIPAA EDI Agreements and instructions for their completion are provided later in this section. The Electronic Remittance Advice EDI Agreement must be prior approved and on file with DXC Technology before an ERA will be made available to the submitter that has been designated by the requesting provider. DXC Technology will notify the EDI Submitter of New Jersey Medicaid’s approval for the submitter to receive the ERA.
HIPAA 837 Claims EDI AgreementEdi Agreement • October 24th, 2018
All New Jersey Medicaid and Charity Care Providers desiring to submit HIPAA formatted electronic claims must complete a HIPAA 837 Claims EDI Agreement as required by HIPAA guidelines. The New Jersey HIPAA 837 Claims EDI Agreement and instructions for their completion are provided later in this section. The EDI Agreement and HIPAA certification received for the specified HIPAA transaction sets must be prior approved and on file with DXC Technology before HIPAA formatted claims may be submitted electronically. DXC Technology will notify the EDI Submitter of New Jersey Medicaid’s approval for the submission of HIPAA formatted electronic claims.
