Statutes, codes, and regulations
New Jersey Administrative Code
Title 10 - HUMAN SERVICESChapter 73 - CASE MANAGEMENT SERVICES
Subchapter 3 - CARE MANAGEMENT ORGANIZATION SERVICES
Section 10:73-3.3 - Provider enrollment and participation

N.J. Admin. Code § 10:73-3.3

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Current through Register Vol. 56, No. 21, November 4, 2024
Section 10:73-3.3 - Provider enrollment and participation
(a) Prior to enrollment as a Medicaid/NJ FamilyCare provider, any agency applying to render Medicaid/NJ FamilyCare CMO services shall first be under contract with the New Jersey Department of Human Services as an approved CMO provider. Such contract shall be in full effect and shall not be currently suspended, terminated or in default.
(b) In order to participate as a provider of CMO services, all providers shall apply to, and be approved by, the New Jersey Medicaid/NJ FamilyCare fee-for-service program as a CMO provider, in accordance with N.J.A.C. 10:49-3 and this subchapter.
1. Applicants may obtain the Medicaid "Provider Application" (FD-20), the Medicaid "Provider Agreement" (FD-62), and the CMS 1513 form at www.njmmis.com, or from:

Gainwell Technologies

Provider Enrollment

PO Box 4804

Trenton, NJ 08650-4804

2. All applicants shall complete and submit the forms to: Department of Children and Families

PO Box 717

Trenton, NJ 08625-0717

Attn: Director, Division of Child Behavioral Health Services

3. The Director, Children's System of Care, will review the contract status of the applicant and will forward the application, if approved, to the Medicaid/NJ FamilyCare program for further processing.
(c) CMO provider applicants will receive notification of approval or disapproval of provider status. If approved, an applicant will be enrolled as a Medicaid/NJ FamilyCare provider and will be assigned a Medicaid/NJ FamilyCare provider number for use in the claim reimbursement process.
(d) If a provider's contract with the Department of Children and Families is in default status or has been suspended or terminated for any reason, or if the provider is no longer approved by the Department of Children and Families, the provider shall immediately be disenrolled as a provider of CMO services until such time as the contract is renewed or reinstated and the Medicaid/NJ FamilyCare program has been notified by the Department of Children and Families that the provider should be reinstated as a provider of CMO services.
(e) If a provider receives notification that the provider's contract with the Department of Children and Families is in default status or has been suspended or terminated for any reason, or if a provider is no longer approved by the Department of Children and Families, the provider shall notify the Division of Medical Assistance and Health Services at the address below within 10 business days: Division of Medical Assistance and Health Services

Office of Provider Enrollment

PO Box 712

Trenton, NJ 08625-0712

(f) A provider shall be held liable for recoupment of any monies paid for services rendered during the time that the provider's contract with the Department of Children and Families is in default status or has been suspended or terminated or during the time that the provider did not meet any other requirements of this subchapter.
(g) All CMO providers shall, at all times, maintain compliance with all applicable State and Federal laws, rules and regulations, including, but not limited to, N.J.A.C. 10:3 and 10:49 and this chapter.

N.J. Admin. Code § 10:73-3.3

Amended by R.2006 d.421, effective 5/21/2007.
See: 38 N.J.R. 2585(a), 39 N.J.R. 2096(a).
Section was "Provider enrollment criteria". Rewrote the section.
Amended by 53 N.J.R. 1492(a), effective 9/7/2021