N.J. Admin. Code § 10:49-2.11

Current through Register Vol. 56, No. 21, November 4, 2024

Section 10:49-2.11 - Recipient Eligibility Verification System (REVS)/Medicaid Eligibility Verification System (MEVS)

(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.

N.J. Admin. Code § 10:49-2.11

Amended by R.1995 d.589, effective 11/20/1995.
See: 27 N.J.R. 2851(a), 27 N.J.R. 4715(b).
Recodified from N.J.A.C. 10:49-2.9 and amended by R.1997 d.354, effective 9/2/1997.
See: 29 N.J.R. 2512(a), 29 N.J.R. 3856(a).
In (a) and (b), substituted "beneficiary" for "recipient"; in (a), substituted "Medicaid Eligibility Identification Number" for "HSP (Medicaid) Case Number", and amended N.J.A.C. reference; added (b)1i; and in (c)2v, substituted "HCFA" for "Health Care Financing Administration. Former section recodified to N.J.A.C. 10:49-2.11.
Recodified from N.J.A.C 10:49-2.10 and amended by R.1998 d.116, effective 1/30/1998 (operative February 1, 1998; to expire July 31, 1998).
See: 30 N.J.R. 713(a).
Inserted references to NJ KidCare throughout. Former N.J.A.C. 10:49-2.11, Medicaid Eligibility Identification Number, recodified to N.J.A.C. 10:49-2.12.
Adopted concurrent proposal, R.1998 d.426, effective 7/24/1998.
See: 30 N.J.R. 713(a), 30 N.J.R. 3034(a).
Readopted provisions of R.1998 d.116 without change.
Amended by R.2003 d.82, effective 2/18/2003.
See: 34 N.J.R. 2650(a), 35 N.J.R. 1118(a).
Rewrote (d).
Amended by R.2008 d.230, effective 8/4/2008.
See: 40 N.J.R. 984(a), 40 N.J.R. 4531(a).
In (a), substituted "an HBID card or an HBID Emergency Services Letter" for "a form that validates Medicaid or NJ FamilyCare eligibility", inserted "or the Card Control Number (CCN) found on the HBID Card" and inserted the last sentence; in the introductory paragraph of (b)1, inserted "/CCN"; in (b)2, deleted the second sentence; added (b)3; in (c)2v, substituted "CMS" for "the HCFA"; and deleted (d).