N.J. Admin. Code § 10:77-2.3

Current through Register Vol. 57, No. 1, January 6, 2025

Section 10:77-2.3 - Provider participation requirements

(a) Requirements for a provider to participate in environmental lead inspection or hazard assessment services shall be as follows:

1. An applicant shall be a local board of health;

2. Each local board of health shall enroll and be approved by the New Jersey Medicaid/NJ FamilyCare programs specifically for reimbursement for this service, including local boards of health previously approved as Medicaid/NJ FamilyCare independent clinic providers;

3. A local board of health not previously approved as a Medicaid/NJ FamilyCare independent clinic provider but wishing to enroll as a Medicaid/NJ FamilyCare-participating provider for environmental lead intervention services shall complete and submit a provider application packet pursuant to N.J.A.C. 10:49-3.2.

i. The completed application packet shall be submitted to:

Gainwell Technologies

Provider Enrollment

PO Box 4804

Trenton, New Jersey 08650;

ii. A provider application can be requested by calling 1-800-776-6334 or downloaded at www.njmmis.com; and

iii. The applicant shall receive written notification of approval or disapproval of its provider status. If approved, the applicant shall be assigned a Medicaid/NJ FamilyCare Provider Number and shall receive a packet which contains a Medicaid/NJ FamilyCare Provider Manual (N.J.A.C. 10:77) and the Fiscal Agent Billing Supplement (FABS);

4. A local board of health previously approved as a Medicaid/NJ FamilyCare independent clinic provider or a local board of health previously issued a provider number but requiring reactivation of its provider number, wishing to perform environmental lead inspection or hazard assessment services needs only to submit a request on local board of health letterhead to:

Division of Medical Assistance and Health Services

Office of Provider Enrollment

Mail Code #9

PO Box 712

Trenton, New Jersey 08625-0712;

5. Upon approval as a Medicaid/NJ FamilyCare provider, the local board of health shall conform to applicable State and Federal laws, rules and regulations, including, but not limited to, N.J.A.C. 10:49 and this chapter; and

6. In order to participate in the New Jersey Medicaid/NJ FamilyCare Program, a local board of health provider shall:

i. Have a valid National Provider Identifier (NPI) number obtained from the National Plan and Provider Enumeration System (NPPES);

ii. Have a valid taxonomy code obtained from the NPPES; and

iii. Remain a provider in good standing by successfully completing provider revalidation, when requested by DMAHS.

N.J. Admin. Code § 10:77-2.3

Amended by 48 N.J.R. 81(a), effective 1/4/2016

Amended by 55 N.J.R. 1292(a), effective 6/19/2023