Current through Register Vol. 56, No. 18, September 16, 2024
(a) In the event a
beneficiary is unable to produce an HBID card or an HBID Emergency Services
Letter or the provider wants more current eligibility data (see N.J.A.C. 10:49)
and the beneficiary's Medicaid or NJ FamilyCare Eligibility Identification
Number or the Card Control Number (CCN) found on the HBID Card is known, the
provider can verify eligibility by calling the Unisys Recipient Eligibility
Verification System (REVS). REVS is accessed by dialing 1(800) 676-6562 or
(609) 587-1955 in the local Trenton area). Complete instructions for using REVS
can be found in the Fiscal Agent Billing Supplement following the second
chapter for each Provider Services Manual. Eligibility can also be confirmed by
inquiring online at www.njmmis.com.
(b) The New Jersey Medicaid/Pharmaceutical
Assistance to the Aged and Disabled (PAAD) program offers providers an optional
method of verifying beneficiary eligibility. The optional system is called
Medicaid Eligibility Verification System (MEVS).
1. A provider can contract with a
Medicaid/PAAD approved vendor that has access to the Medicaid/PAAD eligibility
file. By contracting with a vendor, a provider through MEVS can obtain
eligibility information by entering the Medicaid/PAAD/CCN number or, if the
number is not available, the following data elements: the beneficiary's Social
Security Number and date of birth.
i. For
hospital providers only, name and date of birth may be used.
2. MEVS will contain current
information on eligibility but is no guarantee of eligibility.
3. Providers with access to the internet may
use another option, e-MEVS, to obtain beneficiary eligibility information. This
system is accessible via a secured connection to the NJMMIS website,
www.njmmis.com, and is available to
providers free of charge using a password and ID assigned by the Medicaid/NJ
FamilyCare fiscal agent. Eligibility can also be verified by swiping the HBID
card through a reader provided by an eligibility vendor.
(c) The MEVS intermediary shall be a person,
business, corporation, etc., that has been approved by and contracted with the
Division to provide eligibility information to providers.
1. Applications to be a MEVS intermediary can
be submitted to the Division at any time. If an application is approved, based
on the evaluation criteria in (c)2 below, the Division shall enter into a
contract with the vendor. The application must:
i. Describe the prospective vendor's approach
and plans for accomplishing the work required;
ii. Demonstrate and describe the effort,
skills and understanding of the project necessary to satisfactorily provide the
services; and
iii. Contain all
pertinent information relating to the prospective vendor's organization,
personnel, and experience, and be signed by an authorized representative of the
applying firm.
2. The
Division shall consider the following in evaluating an application:
i. The applicant's general approach and plans
to meet the requirements of the MEVS project;
ii. The applicant's detailed approach and
plans to meet the requirements of the MEVS project;
iii. The applicant's documented
qualifications, expertise, and experience on similar projects;
iv. The applicant's proposed staff's
documented qualifications, expertise, and experience on similar
projects;
v. The applicant's
adherence to the requirements of CMS; and
vi. The fact that the prices charged by the
applicant to subscribers are reasonable.
3. If a request for approval as a MEVS
intermediary is denied or approval withdrawn, the applicant/intermediary may
request an administrative hearing pursuant to
10:49-10.1 and 10.3.
