PROVIDER ENROLLMENT PROCEDURES

ADULT DAY SERVICES (SOCIAL)
NEW JERSEY MEDICAID PROVIDER APPLICATION

Regarding enrollment as an Adult Day Services (Social) New Jersey Medicaid provider:

The Department of Health and Senior Services contracts Unisys 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 Unisys at (609) 588-6036.

To become a provider the following documents will be required by Unisys:

• New Jersey Medicaid Provider Application
• Ownership and Control Interest Disclosure Statement
• Provider Agreement
• Current fee schedule