New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 49 - ADMINISTRATION MANUAL
Subchapter 21 - THE MEDICAID/NJ FAMILYCARE MANAGED CARE PROGRAM
Section 10:49-21.3 - Medicaid beneficiaries
Universal Citation: NJ Admin Code 10:49-21.3
Current through Register Vol. 56, No. 18, September 16, 2024
(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.
Disclaimer: These regulations may not be the most recent version. New Jersey may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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