New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 64 - HEARING AID SERVICES
Subchapter 1 - GENERAL POLICIES
Section 10:64-1.3 - Provisions for provider participation
Current through Register Vol. 56, No. 18, September 16, 2024
(a) In order to participate in the Medicaid/NJ FamilyCare program as a hearing aid provider, the dispenser shall apply to and be approved by the New Jersey Medicaid/NJ FamilyCare program. Application for approval by the New Jersey Medicaid/NJ FamilyCare program as a hearing aid provider requires completion and submission of the "Medicaid Provider Application" (FD-20) and the "Medicaid Provider Agreement" (FD-62).
Gainwell Technologies
Provider Enrollment
PO Box 4804
Trenton, New Jersey 08650-4804
(b) In order to be approved as a Medicaid/NJ FamilyCare participating provider, the dispenser shall have a current valid license to dispense hearing aids from the New Jersey Board of Medical Examiners.
(c) A photocopy of the current valid license shall be provided with the application for enrollment.
(d) Upon signing and returning the Medicaid Provider Application, the Provider Agreement, and other enrollment documents to the fiscal agent for the New Jersey Medicaid/NJ FamilyCare program, the hearing aid dispenser will receive written notification of approval or disapproval. If approved, the hearing aid dispenser will be assigned a provider identifier number. The State's fiscal agent will furnish the provider identifier number, provider number, and will provide an initial supply of pre-printed claim forms.
