N.J. Admin. Code § 10:49-2.10 - Verification of eligibility for Medicaid or NJ FamilyCare; or Pharmaceutical Assistance to the Aged and Disabled (PAAD) services

(a) Each Medicaid or NJ FamilyCare beneficiary, except Nursing Facility beneficiaries, will be issued a Health Benefits Identification (HBID) Card for identification purposes. Each beneficiary will be issued an HBID Emergency Services Letter to use as identification when seeking emergency services prior to receiving the HBID card in the mail. (See Appendix, N.J.A.C. 10:49). This letter contains pertinent information, which the provider will need in order to submit claims for emergency services provided to the beneficiary. This letter is not valid proof of eligibility for Medicaid/NJ FamilyCare and should not be used by the provider for such purposes, except that the letter serves as proof of eligibility only in the event that the client is newly eligible and there is no record of the client when using the eligibility verification system. A request for reimbursement based solely upon the presentation of the Health Benefits Identification Card Emergency Services Letter does not guarantee payment. The beneficiary shall present either the HBID Emergency Services Letter or the HBID Card to the provider, as a proof of identification, every time a service is to be provided. See N.J.A.C. 10:49-2.12 for a description and information about the Medicaid Eligibility Identification Number and see N.J.A.C. 10:49-2.13 for information about the Medicaid and NJ FamilyCare forms or cards that are used to validate eligibility. The Recipient Eligibility Verification System (REVS) or Medicaid Eligibility Verification System (MEVS) shall be used to validate eligibility each time the beneficiary presents the HBID card and requests services (see N.J.A.C. 10:49-2.11).

1. When extended plans of treatment have been approved, it is especially important to review the validation of eligibility form each time a service is provided.

i. Medical authorization or approval of a service by the Division shall not be construed as a guarantee that a person is eligible for the Medicaid or NJ FamilyCare program.

ii. There shall be no reimbursement for services performed after termination of eligibility, except as noted in N.J.A.C. 10:49-5.5(a)9.

Notes

N.J. Admin. Code § 10:49-2.10

Amended by R.1995 d.589, effective 11/20/1995.
See: 27 N.J.R. 2851(a), 27 N.J.R. 4715(b).
Recodified from N.J.A.C. 10:49-2.8 and amended by R.1997 d.354, effective 9/2/1997.
See: 29 N.J.R. 2512(a), 29 N.J.R. 3856(a).
In (a), substituted "beneficiary" and "beneficiaries" for "recipient" and "recipients" and "Medicaid Eligibility Identification Number" for "HSP (Medicaid) Case Number", and amended N.J.A.C. references; and deleted (b), relating to PAAD Programs. Former section recodified to N.J.A.C. 10:49-2.10.
Recodified from N.J.A.C N.J.A.C. 10:49-2.9 and amended by R.1998 d.116, effective 1/30/1998 (operative February 1, 1998; to expire July 31, 1998).
See: 30 N.J.R. 713(a).
Inserted references to NJ KidCare and made corresponding language changes, and changed N.J.A.C. references throughout. Former N.J.A.C. 10:49-2.10, Recipient Eligibility Verification System (REVS)/Medicaid Eligibility Verification System (MEVS), recodified to N.J.A.C. 10:49-2.11.
Adopted concurrent proposal, R.1998 d.426, effective 7/24/1998.
See: 30 N.J.R. 713(a), 30 N.J.R. 3034(a).
Readopted provisions of R.1998 d.116 without change.
Amended by R.2003 d.82, effective 2/18/2003.
See: 34 N.J.R. 2650(a), 35 N.J.R. 1118(a).
In (a), inserted reference to cards following forms throughout.
Amended by R.2008 d.230, effective 8/4/2008.
See: 40 N.J.R. 984(a), 40 N.J.R. 4531(a).
Rewrote the introductory paragraph of (a).