Division of Health Facilities Evaluation and Licensing

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Provider Enrollment Procedures

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.

Health Facilities Licensure Payments

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