N.J. Admin. Code § 10:76-1.3 - Provider participation criteria
(a) To participate
in the Medicaid/NJ FamilyCare program, all providers shall be under contract
with the Division of Mental Health and Addiction Services (DMHAS) as a provider
of PACT services and shall meet the requirements set forth by the DMHAS related
to PACT services in accordance with N.J.A.C. 10:37J.
(b) In order to participate in the
Medicaid/NJ FamilyCare program, all applicants shall complete and submit the
"Medicaid Provider Application" (FD-20) and the "Medicaid Provider Agreement"
(FD-62), as well as a copy of their license provided by DHS, in accordance with
N.J.A.C. 10:190, to:
Division of Medical Assistance and Health Services
Office of Provider Enrollment, Mail Code #9
PO Box 712
Trenton, New Jersey 08625-0712
(c) The applicant will receive written
notification of approval or disapproval of Medicaid/NJ FamilyCare provider
status from DMAHS. If approved, the applicant will be assigned a Medicaid/NJ
FamilyCare Provider Number, and will receive a copy of this chapter as part of
the provider manual.
(d) Prior to
billing for PACT services, those who have previously enrolled, and are
currently approved, as Medicaid/NJ FamilyCare providers in other categories of
service, shall be required to enroll as a PACT provider by completing and
submitted a new provider application and shall receive an additional, unique,
provider identification number for submitting claims for the provision of PACT
services.
(e) Upon approval as a
Medicaid/NJ FamilyCare provider of PACT services, the provider shall conform to
the provisions of this chapter and the provisions of N.J.A.C. 10:49, the
Administration Manual for DMAHS programs.
(f) If a PACT provider loses its license from
DHS, and is unable to provide services, the provider shall notify the Provider
Enrollment Unit, at the address in (b) above, within five business days of
losing the license.
1. The PACT provider will
be disenrolled as a Medicaid/NJ FamilyCare PACT provider until such time as the
license is restored. Once the provider's PACT license is restored by the
Department of Human Services, the provider will be reinstated as a Medicaid/NJ
FamilyCare PACT provider as long as the requirements of N.J.A.C. 10:37J and
this chapter are met and continue to be met.
2. A PACT provider shall be held liable for
recoupment of any monies paid for services during the time that they did not
possess a valid license.
(g) In order to participate in the New Jersey
Medicaid/NJ FamilyCare Program, a PACT services provider shall:
1. Have a valid National Provider Identifier
(NPI) number obtained from the National Plan and Provider Enumeration System
(NPPES);
2. Have a valid taxonomy
code obtained from the NPPES; and
3. Remain a provider in good standing by
successfully completing provider revalidation, when requested by
DMAHS.
Notes
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