Welcome to New Jersey Medicaid: Provider Enrollment 3

Provider Enrollment Applications

Announcement: NEW Provider Revalidation - Existing providers who are submitting a Provider Enrollment Package for the purpose of Revalidation, please click here for instructions and a copy of a new Revalidation Cover Page to be attached and submitted with the appropriate Provider Enrollment Package found in the dropdown below. If the Revalidation Cover Page is not attached to a Provider Enrollment Package intended for Revalidation use; the Revalidation request cannot be processed. New providers, including those providers previously cancelled or disenrolled, requesting re-enrollment in the Medicaid Program simply submit the appropriate Provider Enrollment Package without attaching the new Revalidation Cover Page. Should you have any questions related to the Revalidation process, please contact the Gainwell Technologies Revalidation Unit at 1-833-909-1522 Monday through Friday between 8:00 AM and 4:30PM.
Provider Enrollment Applications
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