New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 67 - PSYCHOLOGICAL SERVICES
Subchapter 1 - INTRODUCTION
Section 10:67-1.3 - Conditions of participation

Universal Citation: NJ Admin Code 10:67-1.3

Current through Register Vol. 56, No. 6, March 18, 2024

(a) To be approved as a Medicaid/NJ FamilyCare provider by the New Jersey Medicaid/NJ FamilyCare program, the psychologist or psychologist specialist shall:

1. Complete and submit the Medicaid/NJ FamilyCare "Provider Application" (FD-20) and the "Medicaid/NJ FamilyCare Provider Agreement" (FD-62).
i. The documents, referenced at (a)1 above, are located as Forms #8 and #10 in the Appendix of the Administration Chapter (N.J.A.C. 10:49--Appendix) at the end of the chapter, and may be obtained from and submitted to:

Gainwell Technologies

Provider Enrollment

PO Box 4804

Trenton, New Jersey 08650-4804

A provider application can also be requested by calling 609-588-6036 or downloaded from the DMAHS fiscal agent website at njmmis.com.

ii. Provider agreements are approved by the: Chief, Provider Enrollment Unit

Division of Medical Assistance and Health Services

PO Box 712

Trenton, New Jersey 08625-0712

2. To be approved by the New Jersey Medicaid/NJ FamilyCare program as a psychological specialist, the psychological specialist shall enclose with the provider application, documentation that he or she:
i. Is a Diplomate of the American Board of Professional Psychology (Diplomate Qualified); or

ii. Has been notified of admissibility to the examination by the American Board of Professional Psychology (Diplomate Eligible).

(b) If the psychologist is providing psychological services to a Medicaid/NJ FamilyCare recipient residing in a nursing facility (NF), or residential health care facility, or a residential treatment center, these facilities shall be Medicaid/NJ FamilyCare approved facilities.

(c) Upon approval as a psychological services provider, the psychologist shall be assigned a Medicaid/NJ FamilyCare provider number.

(d) In order to be approved as a Medicaid/NJ FamilyCare-participating provider, the applicant shall have a valid National Provider Identifier (NPI) obtained from the National Plan and Provider Enumeration System (NPPES) and a valid taxonomy code for "psychologist" or "psychologist specialist" obtained from the NPPES.

(e) Once approved as a Medicaid/NJ FamilyCare provider, the provider shall remain a provider in good standing by successfully completing provider revalidation when requested by DMAHS.

Disclaimer: These regulations may not be the most recent version. New Jersey may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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