N.J. Admin. Code § 10:49-2.12
Current through Register Vol. 56, No. 21, November 4, 2024
Section 10:49-2.12 - Medicaid or NJ FamilyCare Eligibility Identification Number and Health Benefits Identification (HBID) Card(a) 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.(b) 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 in (c) through (g) below.(c) 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.
1. Exception: 23 and 24 are limited to use by the Statewide eligibility determination agency.2. 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.3. 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. i. 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)
iii. 51 New Jersey Veteran's Home (Unit Dose Drugs) (ISS office, which serves the county in which the home is located)iv. 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.)(d) 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
(e) 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.(f) 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) |
(g) For example, an adult Medicaid beneficiary (caretaker/parent) from Bergen County receiving assistance under the AFDC-Related Medicaid program could have the following Medicaid Eligibility Identification Number: Data in image
N.J. Admin. Code § 10:49-2.12
Recodified from N.J.A.C. 10:49-2.10 and amended by R.1997 d.354, effective 9/2/1997.
See: 29 N.J.R. 2512(a), 29 N.J.R. 3856(a).
Changed section name; substituted "beneficiary" and "beneficiaries" for "recipient" and "recipients" and "Medicaid Eligibility Identification Number" for "HSP (Medicaid) Case Number" throughout; in (b)2, inserted "responsible for inspection ... for eligibility processes"; in (b)2i, amended several MDO references and in 34 added "(excluding 800,000 series)"; in (b)2ii, amended several MDO references and deleted 46 (E.R. Johnstone Training and Research Center); in (b)2iii, substituted "New Jersey Veteran's Home" for "Soldier's Homes"; in (c), in 20 and 25 deleted "(under 65 years of age)", in 70 substituted "County Juvenile Residential Facilities" for "Medical Assistance for Aged--A New Jersey State Program", and in 80, substituted "State Juvenile Residential Facilities" for "Refugee Program"; and in (d), inserted reference to exception for presumptively pregnant women. Former section recodified to N.J.A.C. 10:49-2.12.
Recodified from N.J.A.C 10:49-2.11 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; in (b), inserted "23 and 24-- Statewide eligibility determination agency", inserted a new 1, and recodified former 1 and 2 as 2 and 3. Former N.J.A.C. 10:49-2.12, Forms that validate Medicaid eligibility, recodified to N.J.A.C. 10:49-2.13.
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).
Amended by R.2008 d.230, effective 8/4/2008.
See: 40 N.J.R. 984(a), 40 N.J.R. 4531(a).
Section was "Medicaid or NJ FamilyCare Eligibility Identification Number". Rewrote the section.