N.J. Admin. Code § 10:64-1.3 - Provisions for provider participation

Current through Register Vol. 54, No. 7, April 4, 2022

(a) In order to participate in the Medicaid/NJ FamilyCare program as a hearing aid provider, the dispenser shall apply to and be approved by the New Jersey Medicaid/NJ FamilyCare program. Application for approval by the New Jersey Medicaid/NJ FamilyCare program as a hearing aid provider requires completion and submission of the "Medicaid Provider Application" (FD-20) and the "Medicaid Provider Agreement" (FD-62).
1. The documents referenced above are located as Forms No. 8 and No. 9 in the Appendix at the end of the Administration chapter (N.J.A.C. 10:49), and may be obtained from and submitted to:

Gainwell Technologies

Provider Enrollment

PO Box 4804

Trenton, New Jersey 08650-4804

(b) In order to be approved as a Medicaid/NJ FamilyCare participating provider, the dispenser shall have a current valid license to dispense hearing aids from the New Jersey Board of Medical Examiners.
1. An out-of-State hearing aid dispenser shall have comparable documentation from the state in which they are licensed to provide hearing aid services.
(c) A photocopy of the current valid license shall be provided with the application for enrollment.
(d) Upon signing and returning the Medicaid Provider Application, the Provider Agreement, and other enrollment documents to the fiscal agent for the New Jersey Medicaid/NJ FamilyCare program, the hearing aid dispenser will receive written notification of approval or disapproval. If approved, the hearing aid dispenser will be assigned a provider identifier number. The State's fiscal agent will furnish the provider identifier number, provider number, and will provide an initial supply of pre-printed claim forms.


N.J. Admin. Code § 10:64-1.3
Amended by R.2001 d.71, effective 3/5/2001.
See: 32 New Jersey Register 3965(a), 33 New Jersey Register 793(a).
Amended by R.2006 d.289, effective 8/21/2006.
See: 38 New Jersey Register 1385(a), 38 New Jersey Register 3304(a).
In the introductory paragraphs of (a) and (b), and also in (b)1 and (c), substituted "shall" for "must".
Amended by 53 N.J.R. 2222(a), effective 12/20/2021

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