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)