New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 56 - MANUAL FOR DENTAL SERVICES
Subchapter 1 - DENTAL SERVICES; GENERAL PROVISIONS
Section 10:56-1.3 - Provisions for provider participation
Current through Register Vol. 56, No. 18, September 16, 2024
(a) A Doctor of Dental Medicine (DMD) or a Doctor of Dental Surgery (DDS), pursuant to N.J.A.C. 13:35 (incorporated herein by reference), who is authorized to provide dental and surgical services by the State of New Jersey, who is an approved Medicaid/NJ FamilyCare fee-for-service participating provider in accordance with (b) below, who complies with all of the rules of the New Jersey Medicaid/NJ FamilyCare fee-for-service programs, shall be eligible to provide dental and surgical dental services to Medicaid/NJ FamilyCare fee-for-service beneficiaries.
(b) In order to participate in the Medicaid/NJ FamilyCare program as a dentist, a dental practitioner shall apply to, and be approved by the New Jersey Medicaid/NJ FamilyCare program. An applicant shall complete and submit the "Medicaid Provider Application" (FD-20) and the "Medicaid Provider Agreement" (FD-62). The FD-20 and FD-62 can be found as Forms #8 and #9 in the Appendix at the end of Administration Chapter (N.J.A.C. 10:49), and may be obtained from and submitted to:
Unisys Corporation
Provider Enrollment
PO Box 4804
Trenton, NJ 08640-4804
(c) Upon signing and returning the Medicaid/NJ FamilyCare Provider Application, the Provider Agreement and other enrollment documents to the fiscal agent for the New Jersey Medicaid/NJ FamilyCare program, the dentist will receive written notification of approval or disapproval. If approved, the dentist will be assigned a Medicaid/NJ FamilyCare Provider Billing Number, a Medicaid/NJ FamilyCare Provider Service Number, and will be provided with an initial supply of pre-printed claim forms.