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2 N.J.A.R. 369

Shop-Rite Pharmacy; Medical Assistance & Health Services, Division of v
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Citation: 2 N.J.A.R. 369
Decision Date: 1980
Agency: DIVISION OF MEDICAL ASSISTANCE
Synopsis: Shop-Rite Pharmacy submitted prescription claims to the Division of Medical Assistance and Health Services for reimbursement under the Medicaid Program between January and December 1978. One hundred and eighty-two of these claims with missing or incorrect information were returned to the Shop-Rite while the rest continued to be processed for payment. Shop- Rite resubmitted these 182 claims in September of 1979 when they were rejected by the Agency as being submitted out-of-time. The administrative law judge found that N.J.A.C. 10:51-5.30 required that any claim rejected because it lacked information must be resubmitted to the Agency within 180 days of the claimed service rendered. Since Shop- Rite's resubmission was out-of- time, the administrative law judge affirmed the denial of Medicaid reimbursement.
Rule(s) Cited: 10:51-5.30