N.J. Admin. Code § 10:56-1.3

Current through Register Vol. 56, No. 12, June 17, 2024

Section 10:56-1.3 - Provisions for provider participation

(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.

1. Any out-of-State dentist may provide dental and surgical services under this program if he or she meets the documentation and licensing requirements in the State which he or she is practicing, and is a New Jersey Medicaid/NJ FamilyCare participating provider.

2. An applicant shall provide the Division with a photocopy of the current license at the time he or she applies for enrollment.

(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.

N.J. Admin. Code § 10:56-1.3

New Rule, R.1996 d.428, effective 9/16/1996.
See: 28 N.J.R. 3069(a), 28 N.J.R. 4243(a).
Former N.J.A.C. 10:56-1.3, "Prior authorization", recodified to 10:56-1.4.
Amended by R.2001 d.268, effective 8/6/2001.
See: 33 N.J.R. 1554(a), 33 N.J.R. 2666(b).
In (a), inserted references to NJ FamilyCare fee-for-service preceding "participating" and "programs"; substituted "/NJ FamilyCare fee-for-service beneficiaries" for "recipients".
Amended by R.2004 d.25, effective 1/20/2004.
See: 35 N.J.R. 4032(a), 36 N.J.R. 568(a).
Inserted references to NJ FamilyCare throughout.