N.J. Admin. Code § 10:59-1.10

Current through Register Vol. 56, No. 24, December 18, 2024

Section 10:59-1.10 - Third party liability (TPL), excluding Medicare

(a) When a Medicaid/NJ FamilyCare beneficiary has other health insurance, the Medicaid/NJ FamilyCare program requires that such benefits be used first and to the fullest extent. Supplementation may be made for Medicaid/NJ FamilyCare covered services, but the combined total payment shall not exceed the amount payable under the Medicaid/NJ FamilyCare program in the absence of other coverage (see N.J.A.C. 10:49-7.3).

(b) Regardless of the status of a provider's claim with other Regardless of the status of a provider's claim with other third parties, all claims for Medicaid/NJ FamilyCare reimbursement shall be received by the Medicaid/NJ FamilyCare fiscal agent within the time frames specified in N.J.A.C. 10:49-7.2, Timeliness of claim submission.

(c) The Medicaid/NJ FamilyCare program has not established any crossover arrangements with any third party insurer.

N.J. Admin. Code § 10:59-1.10

Amended by R.2001 d.64, effective 2/20/2001.
See: 32 N.J.R. 4098(a), 33 N.J.R. 661(c).
In (a), substituted "beneficiary" for "recipient".
Amended by R.2006 d.297, effective 9/5/2006.
See: 38 N.J.R. 1371(b), 38 N.J.R. 3578(a).
Inserted "/NJ Family Care" throughout.