New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 59 - MEDICAL SUPPLIER MANUAL
Subchapter 1 - MEDICAL SUPPLIES AND DURABLE MEDICAL EQUIPMENT
Section 10:59-1.10 - Third party liability (TPL), excluding Medicare

Universal Citation: NJ Admin Code 10:59-1.10

Current through Register Vol. 56, No. 18, September 16, 2024

(a) When a Medicaid/NJ FamilyCare beneficiary has other health insurance, the Medicaid/NJ FamilyCare program requires that such benefits be used first and to the fullest extent. Supplementation may be made for Medicaid/NJ FamilyCare covered services, but the combined total payment shall not exceed the amount payable under the Medicaid/NJ FamilyCare program in the absence of other coverage (see 10:49-7.3) .

(b) Regardless of the status of a provider's claim with other Regardless of the status of a provider's claim with other third parties, all claims for Medicaid/NJ FamilyCare reimbursement shall be received by the Medicaid/NJ FamilyCare fiscal agent within the time frames specified in 10:49-7.2, Timeliness of claim submission.

(c) The Medicaid/NJ FamilyCare program has not established any crossover arrangements with any third party insurer.

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