LONG TERM CARE NEW JERSEY MEDICAID PROVIDER APPLICATION
Regarding enrollment as a Long Term Care (LTC) 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 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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Division of Health Facilities Evaluation and Licensing
