Provider Information. NOTE: THIS INFORMATION SHOULD ONLY BE THE INFORMATION OF A NEW JERSEY MEDICAID PROVIDER. IF YOU ARE A SECONDARY BILLING SERVICE, PLEASE ADD A SUPPLEMENTARY SECTION 3 AND PLACE BILLING SERVICE INFORMATION ONLY IN SECTION 3.
Appears in 4 contracts
Sources: Pre Enrollment Instructions, Submitter/Provider Relationship Edi Agreement, Electronic Remittance Advice (Era) Edi Agreement, Pre Enrollment Instructions