New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 68 - CHIROPRACTIC SERVICES
Subchapter 1 - GENERAL PROVISIONS
Section 10:68-1.4 - Application for provider status; chiropractor
Current through Register Vol. 56, No. 18, September 16, 2024
(a) Any chiropractor may apply to the New Jersey Medicaid/NJ FamilyCare program for approval as a provider, if he or she is a chiropractor licensed by the State Board of Chiropractic Examiners in accordance with N.J.A.C. 13:44E, or licensed by a comparable state agency in the state in which the chiropractor practices.
(b) See N.J.A.C. 10:49-3for additional requirements for provider participation.
(c) An applicant shall complete a Provider Application (FD-20; see N.J.A.C. 10:49, Appendix #8) and a Provider Agreement (FD-62; see N.J.A.C. 10:49, Appendix #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 license as a chiropractor.
(e) The applicant will receive notification of approval or disapproval from the Division's fiscal agent. If approved, the chiropractor shall be furnished with a provider manual and assigned a Division provider identification number. The chiropractor shall use the assigned provider identification number on all billing documents submitted to the Division's fiscal agent.
