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Division of Developmental Disabilities
Apply to Become a Medicaid/DDD Approved Provider

Step 1: Apply for an NPI for Every Service Location
Go to the National Plan and Provider Enumeration System website and apply for an NPI for each location from which you plan to provide services. If the services you are providing are community based and not provided through a specific location (Community Based Supports or Supported Employment, for example), apply for an NPI for the main location (administrative office).

Step 2: Complete the Combined Application to Become a Medicaid/DDD Approved Provider
Once NPIs have been obtained, complete the Combined Application to Become a Medicaid/DDD Approved Provider.

Providers of residential and in-home "Individual Supports" services must also sign and submit the Attestation for Individual Supports Provider.

Prospective Support Coordination Agencies and Day Habilitation providers must complete the additional steps below prior to submitting Combined Application.

Step 3: Submit the Combined Application By Mail*
Submit the completed application along with any required documents associated with the services you are applying to provide (such as the Day Habilitation Certification necessary for Day Habilitation Services) via mail to:

   Molina Medicaid Solutions
   Provider Enrollment Unit
   PO Box 4804
   Trenton, NJ 08650-4804

*Agencies are strongly advised to retain a copy of their original Combined Application. If a provider agency wishes to add services at a later date, the Combined Application must be submitted again for the new services.

 
 
Additional Steps for Prospective Support Coordination Agencies

Support Coordination is a Medicaid-only service that cannot be provided through the Fiscal Intermediary.

Prior to submitting the Combined Application, agencies interested in providing Division-funded Support Coordination services must:

  1. Review the Division's revised Conflict-Free Policy (revised 01.2015)
  2. Review the Support Coordinator's Guide to Unusual Incident Reporting
  3. Submit an Agency Letter of Interest and an Agency Conflict-Free Policy (both on agency letterhead ) to the Supports Program Helpdesk at: DDD.SuppProgHelpDesk@dhs.state.nj.us 
 
 
Additional Steps for Prospective Day Habilitation Providers

Before submiting the Combined Application, agencies interested in providing Day Habilitation services must apply for and receive Provisional Day Habilitation Certification.

 
 
iRecord Information for Support Coordination Agencies

Agencies approved to provide Support Coordination services can request access to the iRecord.

For the initial request for iRecord access, the Support Coordination Supervisor must complete the iRecord Request Form, scan it, and send it via email to DDD.ITREQUESTS@dhs.state.nj.us. A username and temporary password will be sent to the Support Coordination Supervisor, including instructions on re-setting the initial temporary password.

After the initial account is set up, the Support Coordination Supervisor can log into the iRecord and request additional users.

Change your iRecord password

 
 
 
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