State Requirements

Applicant must not have an active resident state license on PDB in any state.

An affiliation is not required and the applicant may proceed past the "Affiliations" page on the uniform application.

Third Party Administrator.

Please ensure all required documents are submitted to the NIPR's Attachments Warehouse. A list of required documents for Third Party Administrators can be found at https://www.nj.gov/dobi/division_insurance/managedcare/tpa_application.pdf.

Third Party Administrators may reinstate 31 days after expiration date

• Please ensure all required documents are submitted to the NIPR's Attachments Warehouse. A list of required documents for Third Party Administrators can be found at https://www.nj.gov/dobi/division_insurance/managedcare/tpa_application.pdf. 
• Third Party Administrators may reinstate 31 days after expiration date.

Third Party Billing Service  

• Please ensure all required documents are submitted to the NIPR's Attachments Warehouse. A list of required documents for Third Party Billing Service can be found at https://www.nj.gov/dobi/division_insurance/managedcare/tpa_application.pdf. 
• Third Party Billing Service licenses are perpetual. An applicant may reinstate if the license is inactive.

After approval, please allow up to two business days to view and print your license.  Instructions may be found by clicking the state of New Hampshire on the license print page: http://www.nipr.com/map_producer_licensing.htm.

If applicant responds "yes" to one of the background questions please submit supporting documents electronically via NIPR's Attachments Warehouse. The documents may also be submitted to the state via mail, email, or fax.