LONG TERM CARE NEW JERSEY MEDICAID PROVIDER APPLICATION
Regarding enrollment as a Long Term Care (LTC) New Jersey Medicaid
provider:
The Department of Health contracts Molina Medicaid Solutions as the fiscal agent for the processing of Medicaid applications. To access Medicaid applications and for inquiries regarding Medicaid and Medicaid Provider Enrollment, please click on the following link: http://www.njmmis.com or contact Molina Medicaid Solutions at (609) 588-6036.
To become a provider the following documents will be required by Molina Medicaid Solutions:
- New
Jersey Medicaid Provider Application
- Ownership
and Control Interest Disclosure Statement for the facility;
- Agreement
for Nursing Facility Participation and;
- Pharmacy Notification form.
- Long
Term Care (LTC) license
- Administrator's
license; and
- Agreement
between the LTC agency and the Pharmacy.
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