Health Benefits Identification FAQs. A: All cards should be issued throughout the State by February 2007.

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1 1. Q: When are cards being distributed? A: All cards should be issued throughout the State by February Q: What if a beneficiary has a plastic ID card and he/she goes to another county that has not been issued plastic (and is still using paper for services)? A: The provider should accept the plastic ID card and verify eligibility. 3. Q: Is there an exempt population, such as youth who are assigned through DYFS, CMO, or residing in other Counties/States? A: Beneficiaries are assigned plastic ID cards based on the county in which they lived. Beneficiaries who receive paper cards today will receive a plastic card. 4. Q: Only a Card Control Number is on the card; why isn't the Medicaid ID # on the card? A: The Card Control Number is linked to the beneficiary Medicaid ID # on the eligibility file. When a provider verifies eligibility via MEVS, REVS, POS, or emevs before rendering services, this will ensure that the NJMMIS captures an electronic record on the system of "good faith". The Card Control Number helps protect the beneficiary's private health insurance information and reduces fraud and reproduction of the health benefits ID card from being used by another beneficiary. 5. Q: Will the Card Control Number be the same as the Medicaid ID#? A: No, the CCN is a randomly assigned number. 1

2 6. Q: In order to properly bill, how do I obtain the Medicaid ID # from REVS since the plastic card only displays the Card Control Number? A: Follow the steps below: 1. Call REVS at You will be prompted to select option #1 to check for eligibility with the Social Security Number. Or select option #2 to check eligibility with the Medicaid ID. Select 1 or 3 to select by Card Control Number on the Health Benefits ID Card. 2. The REVS system will prompt you to enter the 7-digit Provider ID# (i.e., ). Enter the Provider ID #. 3. REVS will ask for the 9-digit Social Security Number of the beneficiary (i.e., ). Enter the Social Security or the 16-digit Card Control Number. 4. REVS will ask for the 8-digit date of birth of the beneficiary (i.e., 07/15/1995). Enter the date of birth. Note: The Date of Birth will not be required if the CCN is already active. 5. REVS will ask you for a date of service (i.e., 3/15/05). Enter the date of service. 6. REVS will then spell out the first and last name of the beneficiary (i.e., John Doe). You should verify that this is the correct beneficiary. 7. REVS will then tell you the Medicaid ID # to submit on your claims. Press option # 1 to repeat the information or option # 2 to continue. 8. Once REVS option 2 is selected, it will provide you the beneficiary's information (i.e., this recipient is enrolled in Medicare Part A and B for date of service requested). 9. REVS will then prompt you to press option 1 to repeat the eligibility information, option 3 for a new date of service, option 5 for a different beneficiary, option 7 to return to the main menu, or option 9 to end the call. 7. Q: Does the Health Benefits ID card constitute good faith in the same way the paper card did? A: No, it does not. Good faith is established through the verification of eligibility. If eligibility is verified using MEVS, REVS or emevs, good faith is established, subject to the same claims processing edits that exist today. 2

3 8. Q: How do I establish "Good Faith" if I can no longer copy the card because it is not proof of eligibility? A: Providers must verify eligibility before rendering services by using one of the verification eligibility systems to lock in eligibility electronically. 9. Q: Which number should be used on the claim form - the beneficiary Medicaid ID # or the Card Control Number? A: Providers must use the Medicaid ID# on the claim of the beneficiary and not the Card Control Number unless using Point of Sale (POS). 10. Q: Will the beneficiary still receive an HMO card? Should the patient still present both cards? A: Yes to both questions 11. Q: A beneficiary does not have his/her Health Benefits ID card. What do I do? A: Services can still be rendered if the beneficiary does not physically have the card on them as long as the provider has the correct beneficiary Medicaid ID number and date of birth and/or his/her name and Social Security #. The provider needs to verify eligibility before rendering services, through REVS, MEVS, POS, or emevs, to ensure eligibility and that the NJMMIS captures an electronic record on the system of "good faith". When the provider submits a claim, the claim will be paid with the patient's eligibility as long as no other edits post and the claim is clean. The provider may also ask the beneficiary whether or not he/she has an emergency service letter. If 'Yes', then the provider may use the Medicaid ID # on the letter to verify eligibility using one of the eligibility systems. If 'No', then the provider must use the beneficiary's name and Social Security # to access MEVS, REVS or emevs to obtain the Medicaid ID #. If eligibility cannot be confirmed, or if the date of service is more than one year earlier, then the provider should contact the Unisys Provider Services Call Center at Q: Referring to the Emergency Service Letter, how do I define what is an emergency? A: The provider needs to determine if the beneficiary must receive services that day or whether the services can wait a few days; is it a true emergency? The Emergency Service Letter serves the same purpose as the Emergency Paper card today. The Plastic ID card is not an avenue to solve the current eligibility issues. 3

4 13. Q: Is the Emergency State Letter issued right on the spot? A: No, if a beneficiary comes in for services and does not have his/her plastic ID card, providers can verify their eligibility by using one of the eligibility verification systems. If the beneficiary does not have eligibility, the provider should contact one of the County Offices for assistance. 14. Q: The beneficiary using the Health Benefits ID card is not the actual card holder and fraud is suspected. What do I do? A: The provider should call the State Medicaid Fraud Unit at FRAUD5 or Q: Will the eligibility verification systems give you the Card Control Number? A: No. 16. Q: The Eligibility Verification System says "the recipient is not eligible". What do I do? A: The provider needs to contact the MACC office in which the provider resides or the beneficiary needs to contact the office in which he/she received their health benefits. Unisys does not maintain the eligibility file, but receives daily updates from the State regarding eligibility. Reference the MACC and/or CWA telephone numbers on this website for assistance. 17. Q: When using MEVS, REVS or emevs, does the Heath Benefits ID card tell you whether a service is covered? A: No, the Health Benefits ID card does not tell you if a service is covered. MEVS, REVS and emevs are used to verify eligibility of the individual, not to confirm covered services. Currently, providers must have knowledge of the category of eligibility and what services are covered. Providers may verify the eligibility, and then check the appropriate newsletter to ascertain covered services. 18. Q: How do I know when the Health Benefits ID card is activated? A: If the provider uses MEVS, POS, or emevs, then the transaction will be transparent. If the provider uses REVS and receives a Date of Birth prompt, then the Health Benefits ID card has not been activated; however, using the Date of Birth will activate the card. There will not be a return message indicating that the Health Benefits ID card has been activated. 4

5 19. Q: How do I activate a card via REVS? A: Steps: 1. Call For eligibility press 1 then 3 to select by the Card Control Number (CCN) on the Health Benefits ID card (located on the front of the plastic ID card above the patient's name on the left-hand side of the card). 3. Enter the 16-digit Card Control Number that is printed on the Health Benefits ID Card. 4. Enter the 8-digit Birth Date (using the existing date of birth message) as Month, Day, Year; for example, February 17, 1994 would be entered as The date of birth message will only be played if the card is inactive. Once a card has been activated, the date of birth prompt is skipped. REVS will not provide a message that the card is activated. Providers should verify eligibility before rendering services. 20. Q: I'm attempting to use MEVS, REVS or emevs, which has returned an error message regarding the Date of Birth. What do I do? A: This is occurring because the card is being used for the first time and must be activated. The provider should verify the beneficiary's Date of Birth. If an error still exists, the provider may call the HBID Unit to activate the card. Once the card is activated, the provider should use MEVS, REVS or emevs, noting the card control number on the front of the card to verify eligibility. If the Date of Birth is wrong, then the beneficiary or provider must contact the State agency that determined eligibility to correct the Date of Birth on his/her eligibility file. The agency should furnish to the provider the beneficiary's Medicaid ID #, to enable the provider to render services. 21. Q: When using spanned dates, do I have to verify eligibility every time the patient comes in for services or just once a month? A: Providers are not required to check eligibility each day. If a service spans a date of service period, then a provider only needs to check eligibility once for the entire period, assuming they are using MEVS or emevs. REVS will require that eligibility be checked each day. 5

6 22. Q: Do we check the mother's Medicaid ID# for the baby? A: Yes, but Providers must follow Medicaid guidelines regarding age restriction. 23. Q: How do I become a registered Provider on the njmmis.com website so that I can verify eligibility using emevs? A: Steps: 1. Go to 2. Click on Provider Registration 3. All asterisk fields must be completed to complete registration a. Provider name b. Address c. City d. State e. Zip f. Primary Medicaid Provider 7-digit ID g. Telephone # h. Are you registering for access to Medicaid or Charity Care reports? 4. Optional fields are: address and Fax number. 5. Upon completion, click submit. 6. A registered letter with a log in and password is mailed to the provider within 48 hours of receipt by the Unisys Helpdesk. 24. Q: When using the Point of Sale (POS) system, will the card be activated automatically when submitting a claim? Also, am I able to bill using the Card Control Number? A: Yes to both questions. POS is able to process claims using the Card Control Number in addition to the Medicaid ID#. Other claim types cannot because POS is a real-time submission and adjudication process. 25. Q: I'm attempting to use the Health Benefits ID card on a swipe box, but the card is not being read. What do I do? A: The provider should contact their MEVS vendor regarding the swipe box to ensure it is properly set up for the Health Benefits ID cards. If the swipe box has a keypad, the provider can enter the Card Control Number into the swipe box using the keypad. The provider can also use REVS or emevs to obtain eligibility. 6

7 26. Q: How does a Nurse in the field check eligibility if he/she can't use the swipe box? A: The nurse can either: (1) Call his/her main office to check eligibility; or (2) Use his/her cell phone to call REVS and check eligibility. 27. Q: Does MEVS support the Passport system? A: Yes, the Passport system does work with MEVS vendors and is able to add the Card Control Number. 28. Q: For Assisted Living residents - Beneficiaries do not receive a card today. How do I activate the card, if he/she does not have a card? A: Beneficiaries will not receive a card. It is the same process as providers do today. No activation will be needed and providers will still need to check eligibility. The verification systems have also not changed. Providers can still obtain the Medicaid ID# through the verification process by checking the name and Social Security #. The Card Control Number on the plastic card gives providers another option to obtain eligibility information. 29. Q: For foster children - when an adopted child is moved day to day from facility to facility, what kind of cards will the child receive? How will the address information be corrected on a daily basis and will the child be ensured coverage from day one? A: This issue is not specific to the plastic ID cards. The same issue for mailing the paper card applies to this current situation and either the provider works with State/County to determine eligibility or the State/County office is able to issue a temporary paper card. Under the Health Benefits ID card, the same address/mailing issue continues with the provider continuing to pursue existing options to verify eligibility. Instead of an emergency paper card, the State/County office will issue an emergency service letter, which will serve as proof (or nonproof) of eligibility depending on the situation. 7

8 30. Q: Where can I get a swipe box? A Depending on the volume of your practice you may want to consider utilizing one of our free services to check eligibility, such as REVS or emevs. REVS is a telephone-based system accessed by calling a toll free number ( ). REVS can handle up to 20 eligibility inquiries per call. emevs is a web-based system accessed through the njmmis.com site. You must be a registered user of the website in order to utilize this feature. emevs permits you to query eligibility by Card Control Number (CCN) or Name and Date of Birth or Social Security Number (SSN). You can retrieve the Medicaid eligibility ID# that you need to place on your claim, as well as other eligibility information. If, after considering these two options, you still wish to purchase a card swipe box, you may: 1) contact a credit card service vendor or 2) contact a local office supply store or 3) contact your practice management system and / or software vendor or 4) contact Patient Access Solutions, Inc. (866) x25 8