How to become a Medicaid provider in New Jersey
To bill New Jersey Medicaid, enroll through NJMMIS.com Provider Enrollment Applications (downloadable packages by provider type), run by Gainwell Technologies. The process has 6 steps, listed below with the documents the state asks for.
- Enrollment portal
- NJMMIS.com Provider Enrollment Applications (downloadable packages by provider type)
- Steps
- 6
- Documents
- 5
- Plans listed
- 5
On this page
New Jersey Medicaid enrollment at a glance
To bill New Jersey Medicaid, enroll through NJMMIS.com Provider Enrollment Applications (downloadable packages by provider type), run by Gainwell Technologies. The process has 6 steps, listed below with the documents the state asks for.
- Program
- NJ FamilyCare / New Jersey Medicaid (Division of Medical Assistance and Health Services, NJ Department of Human Services)
- Enrollment portal
- NJMMIS.com Provider Enrollment Applications (downloadable packages by provider type)
- Fiscal agent
- Gainwell Technologies
- Application fee
- Some provider types must pay an application fee unless they paid one recently. Proof of a fee paid to Medicare or another state's Medicaid program in the past 5 years can be attached instead. Otherwise the payment goes to the NJ Division of Revenue lockbox with the application. Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts.
- Fingerprinting
- Under federal rules (42 CFR 455.434 and 455.450), the state places provider types in 'limited', 'moderate' or 'high' risk levels. High-risk providers, and anyone who owns 5% or more of one, must submit fingerprints for a criminal background check. The NJMMIS enrollment pages we reviewed do not describe a separate state fingerprinting process.
- Site visit
- Under federal rule (42 CFR 455.432), the state must visit moderate- and high-risk providers before and after enrollment. Every enrolled provider must allow unannounced on-site inspections. The NJMMIS enrollment pages we reviewed do not describe a separate state site visit process.
- Revalidation
- New Jersey revalidates providers every five years under the ACA. To revalidate, file the full enrollment package for your provider type with the Revalidation Cover Page on top; requests without the cover page are not processed. Signatures can be electronic. Send it by secure email, fax or mail to the Gainwell Provider Revalidation Unit. If you don't return the package, claims may be pended or denied. Revalidation Unit: 1-833-909-1522. Federal rule (42 CFR 455.414) requires the state to revalidate every enrolled provider at least once every 5 years.
- Provider manual
- Provider manual
Steps
- Get an NPI
- On NJMMIS.com, choose your provider type and download its enrollment package (several practitioner types now use a consolidated application with one cover page)
- Fill out and sign the application, provider agreement and disclosure forms in the package
- Attach the required application fee or proof it was paid to Medicare or another state in the last 5 years (provider types that owe it)
- Send the package to Gainwell Provider Enrollment and track it with the online Application Status tool
- To serve NJ FamilyCare managed care members, also join the network of each MCO you want to work with
Documents the state asks for
Joining managed-care plan networks
- Credentialing
- About 95% of NJ FamilyCare members are in managed care. A provider contracts and credentials with each MCO separately. The DMAHS pages we reviewed describe no centralized Medicaid credentialing. Each MCO must run a provider relations unit and publish an annual provider manual.
- Plans (state list)
- Aetna Better Health of New Jersey
- Fidelis Care
- Horizon NJ Health
- UnitedHealthcare Community Plan
- Wellpoint (formerly Amerigroup New Jersey)
Frequently asked questions
How do I become a Medicaid provider in New Jersey?
To bill New Jersey Medicaid, enroll through NJMMIS.com Provider Enrollment Applications (downloadable packages by provider type), run by Gainwell Technologies. The process has 6 steps, listed below with the documents the state asks for.
Is there an application fee to enroll in New Jersey Medicaid?
Some provider types must pay an application fee unless they paid one recently. Proof of a fee paid to Medicare or another state's Medicaid program in the past 5 years can be attached instead. Otherwise the payment goes to the NJ Division of Revenue lockbox with the application. Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts.
How often must New Jersey Medicaid providers revalidate?
New Jersey revalidates providers every five years under the ACA. To revalidate, file the full enrollment package for your provider type with the Revalidation Cover Page on top; requests without the cover page are not processed. Signatures can be electronic. Send it by secure email, fax or mail to the Gainwell Provider Revalidation Unit. If you don't return the package, claims may be pended or denied. Revalidation Unit: 1-833-909-1522. Federal rule (42 CFR 455.414) requires the state to revalidate every enrolled provider at least once every 5 years.