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Division of Developmental Disabilities

The Provider Portal contains information about the process required to become a Medicaid/DDD approved provider in the Division's fee-for-service system, inlcuding a link to the Combined Application to Become a Medicaid/DDD Approved Provider.

For questions related to provider enrollment and/or the application process, please contact the Provider Enrollment Help Desk at

How Do I Become a Medicaid/DDD Approved Service Provider?

To become a Medicaid/DDD approved provider of Division-funded services, please follow the steps below.

Please Note: As of June 2015, the Combined Application is open for all services except Individual Supports and Community Transition Services. These two services have been temporarily removed from the Combined Application pending final approval of the Community Care Waiver renewal from the federal Centers for Medicare and Medicaid Services (CMS).

Providers should complete the Combined Application for all other services they are interested in offering.

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 all of the NPIs have been obtained, complete the Combined Application to Become a Medicaid/DDD Approved Provider 

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

Questions? Contact the Division's Provider Enrollment Help Desk at:

*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 Mandatory Application Steps

Additional Step for Providers of Individual Supports

Agencies applying to provide Individual Supports in the Fee-for-Service system must complete, sign, and submit the Attestation for Individual Supports Provider.

Additional Steps for Agencies Interested in Providing Support Coordination Services

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: 

Additional Steps for Agencies Interested in Providing Day Habilitation Services

Agencies with an interest in providing Day Habilitation services must apply for and receive Day Habilitation Certification prior to submitting the Combined Application.
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 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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