ASSISTED
LIVING NEW JERSEY MEDICAID PROVIDER APPLICATION
FOR
ASSISTED LIVING RESIDENCE (ALR)
ASSISTED LIVING PROGRAM (ALP)
COMPREHENSIVE PERSONAL CARE HOME (CPCH)
Regarding
enrollment as an Assisted Living (AL) 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
- New
Jersey Department of Health and Senior Services license;
- Current
fee schedule.
