Current through Register Vol. 56, No. 18, September 16, 2024
(a) The county/municipality shall provide the
WFNJ/GA recipient residing in a nursing facility with a current validation card or letter which will be
utilized to obtain treatment by a Medicaid participating provider/vendor. The agency shall supply a
validation card or letter to each WFNJ/GA recipient at time of opening or reopening of the case and monthly
thereafter to ensure validity through all periods of assistance eligibility. The size and layout of the
validation card or letter are optional. Each card or letter must contain, at a minimum:
1. The name, address, phone number and four-digit municipality code of the
agency;
2. The first and last name(s) of the client(s) for whom
the card or letter applies;
3. The required six-digit case number
and two-digit person number. If the case number does not contain six digits, zeros are to be placed in the
front of the case number to accommodate the entry. A two-digit person number (that is, 01, 02, and so forth)
must be used to identify the person in the eligible unit for whom the services are to be provided. The person
number 01 should be used to reflect the person whose name appears on the case name and person number 02
reflects the person who resides with the case name person in a marital relationship or who represents
themselves as a couple to the community;
4. The expiration
date;
5. A notice to client as follows: This validation form
indicates eligibility for WFNJ/GA benefits and is to be presented to the Medicaid participating provider when
you require medical services; and
6. A notice to Medicaid
participating provider/vendor as follows: Please complete the appropriate claim form according to Medicaid
policies and procedures and forward the claim directly to the Medicaid fiscal agent for claim processing and
payment.
(b) Claims for medical services eligible
under the WFNJ/GA program shall be processed and paid by the fiscal agent when such services are provided by
Medicaid approved providers.
1. When a WFNJ/GA recipient residing in a
nursing home requires medical services from a provider and an appropriate clinic is not available to provide
such services without charge, the client shall have the opportunity to select a Medicaid participating
provider of his or her own choice. A representative of the agency may assist the client in obtaining an
appropriate Medicaid participating provider.
