SOP
Job build to assist Advocates when handling calls in regards to eligibility and discrepancies.
Community & State Eligibility Discrepancy and Recertification Standard Operating Procedure (SOP)
A plan for childless adults who meet income requirements?
NJ FamilyCare ABP
How will you determine member eligibility besides Facets?
By calling Unisys: 1-800-676-6562; Provider ID: 6231004
Who is the transportation vendor for the state of NJ?
Logisticare
Which plans have copayments?
NJ FamilyCare C and D
Job aid utilize to assist advocates when handling calls in regards to other insurance coordination.
Community & State Coordination of Benefits (COB)
Standard Operating Procedure (SOP)
Plan for Pregnant Woman that fall between 0 to 205% FPL
NJ FamilyCare A
Will a baby be covered for medication on the first 60 days of birth?
Yes, by contacting a SME to add a newborn in RX claims
Who is the Vision Vendor for the state of NJ
March Vision Care
Which plan has a premium to pay?
NJ FamilyCare D
This SOP provides the process for Customer Care professionals (CCP) to handle inquiries regarding benefits.
Community & State - CCP Quoting Benefits, Benefit Limits and Limit Exceptions Standard Operating Procedure (SOP)
Program focused on serving disabled individuals
DDD (Division of Developmental Disability) Clients
Member's enrolled in NJ FamilyCare plan B-D for more than 90 days can disenroll during what dates?
October 1st through November 15th
Which NJ plan provides Home and Community Based Services (HCBS)
MLTSS
What type of person does not pay copays for the NJ FamilyCare C and D plans?
Alaskan Natives and Native Americans under the age of 19
This SOP provides the process for (CCPs) to handle calls from NJ Managed Long Term Services and Support members regarding critical incidents.
New Jersey (MLTSS) Critical Incident Report Standard Operating Procedure (SOP)
Plan for Families that fall between 200% to 355% FPL
NJ FamilyCare D
How can MLTSS member change their address?
By contacting Contact the local County Welfare Agency (Board of Social Services) or local County Area Agency on Aging (AAA) - Aging and Disability Resource Connection (ADRC)
What benefit provides physical modifications/adaptations to a participant's private primary residence.
Residential Modifications
Provide 3 services that DO NOT require cost share for NJ FamilyCare C & D
The job aid utilized to assist CCPs in handling calls regarding NJ Managed Long-Term Services and Support Services.
NEW JERSEY MEDICAID Managed Long Term Services and Supports Services (MLTSS) One Source Job Aid
Programs are focused on serving frail, elderly, and disabled individuals. The program combines traditional health care benefits and long-term services and support.
NJ FamilyCare ABP with MLTSS
Name 2 specialist that DO NOT require referrals
•Emergency Services.
•OB/GYN.
•Optometrists.
•Dermatologists.
•Mental Health/Substance Use Professionals.
•Chiropractors.
•Dentists, including Pediatric Dentists or other Dental Specialists.
Which behavioral health services are still covered under FFS
Targeted case management
Programs in assertive community treatment (PACT)
Behavioral health homes (BHH)
Community support services
Total annual co-pays will not be more than __ of the member's family yearly income and who is responsible for keeping track of the total copay per year?
5%, the member