N.J. Admin. Code § 10:56-1.6

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

Section 10:56-1.6 - Reimbur sement based on specialist designation

(a) To obtain reimbursement as a specialist in the Medicaid/NJ FamilyCare programs, a specialist shall:

1. Obtain a specialty certification from the licensing agency of the State of New Jersey or of the state where dental services are to be rendered; or

2. In those states not requiring specialty certification:

i. The specialist shall be a diplomate of a specialty board recognized by the American Dental Association or shall meet the minimum requirements for that specialty as stipulated by the American Dental Association.

(b) Any provider who meets the qualifications in (a) above and desires specialist reimbursement shall submit proof of specialist certification as described above to:

Unisys

Provider Enrollment Unit

PO Box 4801

Trenton, New Jersey 08650-4801

(c) Specialist reimbursement shall be limited to the following specialties:

1. Oral and Maxillofacial Surgery;

2. Endodontics;

3. Pedodontics--Pediatric Dentistry;

4. Orthodontics;

5. Periodontics; and/or

6. Prosthodontics.

N.J. Admin. Code § 10:56-1.6

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. 10:56-1.6, "Special dental services", recodified to 10:56-2.3.
Amended by R.1998 d.353, effective 7/20/1998.
See: 30 N.J.R. 514(a), 30 N.J.R. 2654(a).
In (b), updated the address.
Amended by R.2007 d.36, effective 2/5/2007.
See: 38 N.J.R. 3419(a), 39 N.J.R. 479(a).
Rewrote (a); in (b), substituted "shall" for "is required to" and substituted "Unisys" for "UNISYS"; and in the introductory paragraph of (c), substituted "shall" for "will".