New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 58 - NURSE MIDWIFERY SERVICES
Subchapter 1 - GENERAL PROVISIONS
Section 10:58-1.4 - Application for provider status; certified nurse midwife
Current through Register Vol. 56, No. 18, September 16, 2024
(a) Any nurse midwife may apply to the New Jersey Medicaid/NJ FamilyCare programs for approval as a Medicaid/NJ FamilyCare provider, if he or she:
(b) See N.J.A.C. 10:49-3for additional requirements for provider participation.
(c) An applicant shall complete a Medicaid Provider Application (FD-20; see N.J.A.C. 10:49, Appendix, Form #8) and a Medicaid Provider Agreement (FD-62; see N.J.A.C. 10:49, Appendix, Form #9). The forms may be obtained from, and shall be submitted to:
Gainwell Technologies
Provider Enrollment
PO Box 4804
Trenton, NJ 08650-4804
(d) The application and agreement shall be accompanied by a photocopy of the applicant's current:
(e) The applicant will receive notification of approval or disapproval from the Medicaid/NJ FamilyCare fiscal agent Gainwell Technologies. If approved, the CNM shall be furnished with a provider manual and assigned a Medicaid/NJ FamilyCare provider identification number. The CNM shall use the assigned provider identification number in all communication with the Medicaid/NJ FamilyCare programs and/or the fiscal agent.