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New Jersey Medicaid Patient Verification

Recipient Eligibility Verification System (REVS)/Medicaid Eligibility Verification System (MEVS)

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 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.

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).

    • 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.
      • For hospital providers only, name and date of birth may be used.
    • MEVS will contain current information on eligibility but is no guarantee of eligibility.
    • 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.
    • 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.
    • 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 below, the Division shall enter into a contract with the vendor. The application must:
      • Describe the prospective vendor's approach and plans for accomplishing the work required;
      • Demonstrate and describe the effort, skills and understanding of the project necessary to satisfactorily provide the services; and
      • 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.
    • The Division shall consider the following in evaluating an application:
      • The applicant's general approach and plans to meet the requirements of the MEVS project;
      • The applicant's detailed approach and plans to meet the requirements of the MEVS project;
      • The applicant's documented qualifications, expertise, and experience on similar projects;
      • The applicant's proposed staff's documented qualifications, expertise, and experience on similar projects;
      • The applicant's adherence to the requirements of CMS; and
      • The fact that the prices charged by the applicant to subscribers are reasonable.
    • If a request for approval as a MEVS intermediary is denied or approval withdrawn, the applicant/intermediary may request an administrative hearing pursuant to N.J.A.C. 10:49-10.1 and 10.3.

Medicaid or NJ FamilyCare Eligibility Identification Number and Health Benefits Identification (HBID) Card

Each Medicaid or NJ FamilyCare beneficiary will be issued a permanent, plastic identification card, the Health Benefits Identification (HBID) Card. The front of the card will include the beneficiary's name and a 16-digit Card Control Number (CCN). The back of the card will include a magnetic strip, which electronically stores the beneficiary's name and CCN.

A Medicaid or NJ FamilyCare Eligibility Identification Number consists of 12 digits, which includes a two digit Person Number. The Medicaid or NJ FamilyCare Eligibility Identification Number is automatically linked in the Medicaid/NJ FamilyCare computer system to the beneficiary's CCN number on the HBID Card. The provider will only need to know the CCN number to verify beneficiary eligibility. The beneficiary's Medicaid/NJ FamilyCare Eligibility Identification Number will be provided when eligibility is verified and this number must be entered on the claim when seeking reimbursement. The components of a Medicaid or NJ FamilyCare Eligibility Identification Number as it is initially assigned to a beneficiary are described below.

The first two digits usually designate the county of residence as follows: AtlanticGloucester

01--Atlantic

08--Gloucester

15--Ocean

02--Bergen

09--Hudson

16--Passaic

03--Burlington

10--Hunterdon

17--Salem

04--Camden

11--Mercer

18--Somerset

05--Cape

12--Middlesex

19--Sussex

06--Cumberland

13--Monmouth

20--Union

07--Essex

14--Morris

21--Warren

23 and 24  Statewide eligibility determination agency.

Exception: 23 and 24 are limited to use by the Statewide eligibility determination agency.

For some adult beneficiaries (that is, the Medicaid Only program and New Jersey Care . . . Special Medicaid programs for Aged, Blind, and Disabled) the first two digits of the Medicaid Eligibility Identification Number designate the county of residence where eligibility was originally determined but not necessarily the location where the beneficiary is currently residing. In these instances, when the beneficiary moves to another county, the beneficiary retains the Medicaid Eligibility Identification Number of the original county of application.

For beneficiaries in certain State or county facilities, the first two digits of the Medicaid Eligibility Identification Number designate the facility where the beneficiary resides. In a few unique situations, the first two digits designate a special State program. The following list identifies the first two digits used to identify a State or county facility or a special State program. Following the name of the facility and enclosed in parentheses, is the Institutional Services Section (ISS) office responsible for inspection of care, periodic medical reviews in the facility and eligibility processes serving that facility. For those facilities below marked by an asterisk (*), it should be noted that when the first two digits of a Medicaid Eligibility Identification Number are used to identify more than one facility, a specific series of numbers for the fifth through 10th digits shall be used to designate the second or third facility, as well as to designate the sequential identification number of the Medicaid beneficiary.

Identification of State and county psychiatric facilities:

31  Greystone Park Psychiatric Hospital (Central ISS office)

32  Trenton Psychiatric Hospital (Southern ISS office)

*32 (300,000 series) Forensic Psychiatric Hospital (Southern ISS office)

*32 (600,000 series) Senator Garrett W. Hagedorn Center for Geriatrics-Psychiatric Section (Central ISS office)

34  Ancora Psychiatric Hospital (Southern ISS office) (excluding 800,000 series)

37  Bergen Regional Medical Center (Central ISS office)

38  Essex County Hospital Center--Cedar Grove (Central ISS office)

39  Camden County Psychiatric Hospital (Southern ISS office)

ii.  Identification of Intermediate Care Facilities/Mental Retardation

41  Vineland Developmental Center (Southern ISS office)

42  North Jersey Developmental Center (Totowa) (Central ISS office)

43  Greenbrook Regional Center (Central ISS office)

44  Woodbine Developmental Center (Southern ISS office)

45  New Lisbon Developmental Center (Southern ISS office)

47  Woodbridge Developmental Center (Central ISS office)

48  Hunterdon Developmental Center (Central ISS office)

51 New Jersey Veteran's Home (Unit Dose Drugs) (ISS office, which serves the county in which the home is located)

90 Division of Developmental Disabilities Community Care Services (Waiver and Non-Waiver) and Special Residential Services, Statewide. (ISS office, which serves the county in which the beneficiary resides.)

The third and fourth digits of the 12-digit Medicaid Eligibility Identification Number designate the category under which a person was determined eligible for the New Jersey Medicaid program. For some adult beneficiaries (that is, the Medicaid Only program and New Jersey Care . . . Special Medicaid programs for Aged, Blind, and Disabled) the third and fourth digits of the Medicaid Eligibility Identification Number will not change from program 20 and 25 (meaning the individual is disabled and under 65 years of age) to 10 and 15 (meaning the individual is aged--65 years of age or older) when beneficiaries reach age 65.

10  Aged--SSI related (65 years of age or older)

15  Aged--Medically Needy (65 years of age or older)

20  Disabled--SSI related

25  Disabled--Medically Needy

30  AFDC-Related Medicaid. New Jersey Care . . . Special Medicaid program for pregnant women and children are included in this category.

35  Medically Needy (children and pregnant women)

50  Blind--SSI related

55  Blind--Medically Needy

60  Children (If first two digits are 01 to 21, the individual is under supervision of the Division of Youth and Family Services. If the first two digits are greater than 21, the individual is institutionalized.

70  County Juvenile Residential Facilities

80  State Juvenile Residential Facilities

The fifth through the tenth digits of the Medicaid Eligibility Identification Number designate the sequential identification number of the Medicaid beneficiary with the exception of presumptively eligible pregnant women (98-99) who are assigned those numbers.

The 11th and 12th digits of the Medicaid Eligibility Identification Number designate the specific Person Number assigned to each beneficiary.

01-04

Adult (any age)

05

Pregnant woman

06-09

Adult (any age)

10-19

Ineligible spouse

20-39

Children under 19

40-49

Medicaid special (Children under 21 but not

 

under 19)

Forms that validate Medicaid eligibility

A New Jersey Medicaid provider may verify a person's Medicaid eligibility by using the identification information on either:

    • Health Benefits Identification (HBID) Card (see N.J.A.C. 10:49-2.15);
    • HBID Emergency Services Letter (see N.J.A.C. 10:49-2.15); or
    • "Validation of Eligibility" (FD-34) (see N.J.A.C. 10:49-2.16).

Citation

N.J.A.C § 10:49-2.10

N.J.A.C § 10:49-2.11

N.J.A.C § 10:49-2.12

N.J.A.C § 10:49-2.13 

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