N.J. Admin. Code § 10:49-21.3

Current through Register Vol. 56, No. 23, December 2, 2024

Section 10:49-21.3 - Medicaid beneficiaries

(a) The Medicaid/NJ FamilyCare Managed Care Program is a mandatory enrollment program for AFDC and AFDC-related New Jersey Care pregnant women and children, Aged, Blind and Disabled (ABD) individuals without Medicare and NJ FamilyCare beneficiaries and is offered to the Medicare-Medicaid dual eligible beneficiary as an alternative to the existing Medicaid fee-for-service program.

(b) Medicaid/NJ FamilyCare beneficiaries enrolled in HMOs receive two identification cards.

1. One card is issued by the HMO and appropriate toll-free telephone numbers are indicated on the card. These telephone numbers allow the provider to inquire whether a service the provider intends to perform will be covered or if the provider needs a prior approval.

2. The second card issued is the same Health Benefits Identification (HBID) card issued to all beneficiaries. Questions about covered services should be referred to the HMO's toll-free number. Providers can also utilize the REVS/MEVS/eMEVS program to identify managed care organization eligibility and/or inquire about the HMO enrollment status.

N.J. Admin. Code § 10:49-21.3

Amended by R.2008 d.230, effective 8/4/2008.
See: 40 N.J.R. 984(a), 40 N.J.R. 4531(a).
In (a) and the introductory paragraph of (b), inserted "/NJ FamilyCare"; in (a), deleted "--New Jersey Care 2000" following "Program", inserted ", Aged, Blind and Disabled (ABD) individuals without Medicare and NJ FamilyCare beneficiaries" and substituted "AFDC-related" for "AFDC related" and "Medicare-Medicaid dual eligible" for "SSI Medicaid"; and rewrote (b)2.