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Becoming a New Jersey Medicaid Provider

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  2.  » For Providers
  3.  » Becoming a New Jersey Medicaid Provider

Intensive In-Community (IIC) and Behavioral Assistance (BA), Intensive In-Home (IIH) and Individual Support Services (ISS)

The moratorium is lifted, however, the Division of Children’s System of Care has closed the window for applying to become a Medicaid Provider for the Children's System of Care (DCSOC). Please check back to this page for additional information when a Request for Information/Proposal (RFI/RFP) is sought by the Division. When this occurs, the RFI/RFP will be listed on the DCF website. The below listed information can assist you in understanding the Medicaid application process.

In order to enroll as a New Jersey Medicaid provider for the Division of Children’s System of Care you can contact Unisys Provider Services at 1-800-776-6334 or the Division of Medical Assistance and Health Services' (Medicaid) Provider Enrollment Office at 609-588-2905. This Unit can direct you on the completion process for enrollment which will include but may not be limited to the following enrollment package:

  • Signature Authorization Form
  • Provider Application FD-20
  • Provider Agreement FD-62
  • Disclosure of Ownership and Control Interest Statement (CMS 1513)
  • Provider Information
  • Becoming a New Jersey Medicaid Provider

Please Note:

CSOC currently has lifted the moratorium on certifying new agencies, medical / mental health practices, or individuals seeking to become enrolled as providers of Intensive In-Community (IIC)/Behavioral Assistance (BA) mental health rehabilitative services as well as Intensive In Home (IIH) and ISS services. Please check this site periodically for any updates on requesting RFI/RFPs.

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Cape Atlantic INK
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