N.J. Admin. Code § 10:49-3.4

Current through Register Vol. 56, No. 23, December 2, 2024

Section 10:49-3.4 - Medicaid or NJ FamilyCare provider billing number

(a) A seven digit Provider Billing Number shall be assigned by the fiscal agent to all providers approved for participation. The Provider Billing Number shall be entered upon all claims submitted in accordance with the instructions in the Fiscal Agent Billing Supplement. The Provider Billing Number should also be referenced in all written and telephone inquiries.

(b) Practitioners, as defined in (c)1 below, approved for participation, shall also be assigned a seven digit Provider Servicing Number by the Program fiscal agent. The Provider Servicing Number is an identification number which shall be entered upon all claim submittals in accordance with the instructions in the Fiscal Agent Billing Supplement.

(c) Providers who, for billing purposes, need a referring, ordering or prescribing practitioner's individual Provider Servicing Number, shall contact that practitioner or the fiscal agent, or shall access the Provider Servicing Number Directory, to obtain the number. A practitioner who does not participate in the Medicaid or NJ FamilyCare program will not have a Provider Servicing Number. In the absence of the referring, ordering or prescribing practitioner's individual Provider Servicing Number, providers must enter seven fives (5's) for non-participating out-of-State providers or seven sixes (6's) for non-participating in-State providers to indicate non-participation in the New Jersey Medicaid or NJ FamilyCare program. Providers may contact the Medicaid/NJ FamilyCare Fiscal Agent for a copy of the participating provider directory. In addition, providers may obtain servicing and prescribing numbers at http://www.njmmis.com.

1. Each participating practitioner (that is, physician, certified nurse midwife, advanced practice nurse, chiropractor, dentist, optometrist, podiatrist, or psychologist) shall supply his or her individual Provider Servicing Number to other providers when referring a Medicaid or NJ FamilyCare beneficiary for services, or ordering or prescribing on his behalf.

(d) A shared health care facility (SHCF) (see 10:49-4.1 ) is assigned a registration code (Shared Health Care Facility Number), which must appear on a claim form submitted to the fiscal agent by every member of the SHCF. In addition, each practitioner rendering a service in a shared health care facility must indicate his or her Provider Billing Number and individual Provider Servicing Number on the claim form (see Fiscal Agent Billing Supplement following the second chapter of each Provider Services Manual).

N.J. Admin. Code § 10:49-3.4

Amended by R.1997 d.354, effective 9/2/1997.
See: 29 New Jersey Register 2512(a), 29 New Jersey Register 3856(a).
Rewrote (a) and (b); and in (c)1, inserted reference to certified nurse practitioner/clinical nurse specialist.
Amended by R.1998 d.116, effective 1/30/1998 (operative February 1, 1998; to expire July 31, 1998).
See: 30 New Jersey Register 713(a).
Inserted references to NJ KidCare and made corresponding language changes throughout.
Adopted concurrent proposal, R.1998 d.426, effective 7/24/1998.
See: 30 New Jersey Register 713(a), 30 New Jersey Register 3034(a).
Readopted provisions of R.1998 d.116 with changes, effective 8/17/1998.
Amended by R.2003 d.82, effective 2/18/2003.
See: 34 New Jersey Register 2650(a), 35 New Jersey Register 1118(a).
Rewrote (c).
Amended by R.2004 d.334, effective 9/7/2004.
See: 36 New Jersey Register 312(a), 36 New Jersey Register 4136(a).
In (c), substituted "advanced practice nurse" for "certified nurse practitioner/clinical nurse specialist" in 1.