Provider Credentialing in New York: NYS Medicaid (eMedNY), Managed Care Plans, Medicare and Revalidation

Six programs, six separate applications. The middle column is only what an agency, statute or plan has put in writing; it is not a forecast for any one file.

The eMedNY Provider Enrollment Guide lays out four stages: obtain an NPI from NPPES, apply for new enrollment (or reinstatement) for your provider type in the Provider Services Portal, let Department of Health staff review it, and receive a written approval or denial. Reviewers contact applicants electronically, and the guide asks you to answer "as soon as possible."

The portal's reach widened in stages. The April 2026 Medicaid Update announced that organizational provider types (groups, institutions and businesses) could now enroll online alongside practitioners, that credentialing staff could work in the portal, and that group practices with only one enrolled practitioner should stay on paper until July 2026, when paper ended. The Department of Health's revalidation page now calls the PSP "the new, mandatory online platform" and says paper processes were discontinued as of May 2026.

Two consequences for anyone who enrolled years ago on paper. First, an applicant whose enrollment lapsed applies for reinstatement in the portal rather than as a brand-new provider. Second, the paper forms still sitting in many offices are now the wrong path; an application on an outdated form version was already being rejected before paper ended.

The state's PSP New Practitioner Enrollment training deck (February 10, 2026) is the most detailed description of how the portal behaves:

• Everyone gets their own NY.GOV ID business account. Practitioners, credentialers and office staff each need one, with multifactor authentication (Okta Verify, Google Authenticator, text or voice call) and identity proofing. A shared office login is not an option. The PSP "What's New" log adds that, since September 4, 2026, a Health Commerce System (HCS) account can also be used to sign in.
• The draft expires. "Once an application is started, it must be completed and submitted within 45 calendar days," or the application is deleted and you begin again. The portal shows a Days Remaining counter.
• Four milestones. The application is split into four milestones of several steps each; Milestone 1 must be finished to unlock Milestones 2 through 4. The EFT form is downloaded inside Milestone 2.
• Staff prepare, the practitioner signs. Credentialers may start and complete the application, but the practitioner must e-sign and submit it personally, and the deck shows a separate credentialer access attestation.
• Applicant type matters. The first screen asks whether you are enrolling as a fee-for-service billing provider or as an OPRA (ordering, prescribing, referring, attending) professional who will not bill.
• Uploads. Supporting documents are added in the portal; accepted formats in the deck include PDF, Word, Excel, JPEG, TIFF and plain text.

Keep the Application ID from the confirmation email. The state calls it "the number you will be required to use to track the status of your enrollment application." For help, the deck lists the NY.GOV ID help desk at 1-844-891-1786, the Bureau of Provider Enrollment at providerenrollment@health.ny.gov, and the eMedNY Call Center at (800) 343-9000.

To check NY Medicaid provider enrollment status, open Track Application in the Provider Services Portal and enter the Application ID; that lookup also requires the practitioner's SSN, date of birth and the practice location ZIP code, or you can click the Application ID from your own dashboard. The statuses in the state's training deck:

There is a second, public way to see where a provider stands. eMedNY's managed care network page points plans to the Medicaid Enrolled Provider Listing (who is enrolled) and the Medicaid Pended Provider Listing (who has applied and is not enrolled yet), both updated weekly. If a plan says it cannot load you, those two lists are usually what it is reading. For the national picture of how status checks work in other states, see our Medicaid provider enrollment hub.

New York does not put a day count for Medicaid enrollment in statute, and the current eMedNY pages publish none. The plainest official statement is from the May 2023 Medicaid Update, written as the pandemic-era temporary enrollment program closed: "It can take up to 120 days to complete processing of an application." Treat that as the state's own outer marker, not a promise.

Three portal rules shape the real timeline far more than the review queue does:

• An unsubmitted application is deleted at 45 calendar days, and every day spent waiting on a signature or a missing document comes out of that window.
• An Additional Information Required request has its own 45-day limit, so an answer that sits in an unread inbox can sink the file.
• The effective date comes from the Department of Health's determination letter. Visits before it are not something to bill New York Medicaid for on the assumption that the date will reach back.

eMedNY's application fee page lists the fee as $750 for 2026 and explains that 42 CFR 455.460 requires it "for certain provider types and enrollment transactions"; the portal itself tells you whether your application owes it. The fee is waived if you are enrolled in Medicare or have already paid it to Medicare. A hardship waiver can be requested with the application, is reviewed by CMS, and must include a balance sheet or other financial statement when the hardship is financial.

Screening follows the federal limited, moderate and high risk levels in 42 CFR Part 455, and New York ties revalidation frequency to them (see the next section). We did not find a current New York page assigning each provider type to a level, so we do not list one here.

New York also paused new enrollment for certain classes. The Department of Health's revalidation page lists temporary moratoriums on laboratories; durable medical equipment, prosthetics, orthotics and supplies; applied behavior analysis; licensed home care services agencies; pharmacies; and managed long term care plans, including partial capitation, Medicaid Advantage Plus and PACE. It gives no end date and says enrolled providers in those classes must still revalidate when notified. Physicians, therapists and most outpatient practices are not on that list.

An MMIS number alone does not get a claim through. The enrollment guide says an Electronic Transmitter Identification Number (ETIN) is required for "any electronic transaction in eMedNY," including claims and access to ePACES. A newly enrolled provider files the ETIN certification on form 490602; a provider joining an existing ETIN, such as a new member of a group, uses form 490501. Do not send claims on the ETIN until eMedNY confirms it is set up.

ePACES enrollment then needs the Medicaid provider ID, the ETIN and an email address. New York issues remittances weekly. Payments go to the EFT account on file (EFT enrollment form 701101) unless that form was rejected, and the guide notes paper checks are held "two weeks and two days" before release. Billing policy starts with the Information for All Providers manual and then the manual for your provider type.

New York is revalidating every enrolled provider. The Department of Health's Provider Revalidation page (revised September 2026) says Phase 1 notifications began in July 2026 and the work runs through June 2028, and it sets ongoing frequency by risk: high-risk providers every 3 years, moderate-risk every 4, limited-risk every 5.

1. Wait for the letter. The page says "do not begin your revalidation until you receive an official notification letter." Notices arrive by email and USPS; eMedNY's revalidation page says email comes from ProviderEnrollment@acentra.com.
2. Submit in the portal within 123 calendar days of the first letter. A reminder follows 60 days after the first notice, then a termination notice 30 days after that, which gives 33 days before termination takes effect. Submitting before that date removes the termination.
3. Clean up the record while you are in it. The PSP log (October 2, 2026) added one-click closing of outdated locations and end-dating of old managing-employee records during revalidation.

Two newer tools make this manageable for a group. Since September 10, 2026, notices go to both the primary and the secondary email on a provider file; the state suggests the provider's own address as primary and a shared credentialing inbox as secondary, and it will bulk-add one secondary address to 25 or more provider files on request. And a public dataset, Medicaid Enrolled Provider – Revalidation Notifications Sent, lists every provider who has been sent a notice, with the scheduled termination date if nothing is filed within 123 days. Checking your NPIs against it monthly is how a group avoids learning about a missed letter from a denied claim.

For any practice that wants Medicaid managed care patients, state enrollment is only the entry ticket. eMedNY's Medicaid Managed Care Network Providers page states the rule: under the 21st Century Cures Act, every Medicaid Managed Care and Child Health Plus network provider must be enrolled with the state, and a plan that flags you as not actively enrolled will remove you from its network unless you enroll. Plans can enroll you as a billing provider or, if you only order or refer, as an OPRA professional.

Which plans you will need depends on the county. The Department of Health's June 2026 managed care enrollment report lists these mainstream plans across the state: Anthem Blue Cross and Blue Shield, Capital District Physicians' Health Plan, Excellus Health Plan, Fidelis Care, Healthfirst, HIP of Greater New York, Highmark Western and Northeastern New York, MetroPlus Health Plan, Molina Healthcare of New York, MVP Health Plan and UnitedHealthcare, plus special needs plans such as Amida Care, MetroPlus SN and VNS Choice SNP. New York City and an upstate county can have very different line-ups, so build the plan list from the counties where your patients live.

Enrollment with the state does not create a contract with any of them. Each plan runs its own credentialing (most read your CAQH profile) and offers its own agreement, under the state timing rules in the next section. Our payer-by-payer credentialing hub covers the national carriers on this list.

New York writes credentialing timing into two parallel statutes: Public Health Law 4406-d for HMOs and Insurance Law 4803 for insurers. Both, in the versions on the Senate site (most recent revision April 17, 2020), say:

• 60 days. Within sixty days of a completed application the plan must tell the professional whether he or she is credentialed or whether more time is needed.
• 21 days. When a third party's delay in sending documents is the holdup, the plan must make its final determination within twenty-one days of receiving them.
• Provisional credentialing for a newly licensed or relocated professional joining a group practice. If the completed application is neither approved nor declined within sixty days, the professional is "deemed provisionally credentialed" and may participate in network starting the day after the sixtieth day, provided the group gives the plan written notice accepting the refund terms. If the application is later denied, the group refunds the difference between in-network and out-of-network payment and may not bill the patient beyond cost-sharing. A provisionally credentialed physician cannot be designated as a patient's primary care physician until fully credentialed.
• Hospital-employed physicians. Section 4406-d(1)(c) adds a provisional path for newly licensed or relocated physicians joining a general hospital, diagnostic and treatment center or certain mental hygiene facilities, with payment for up to sixty days after the completed application if credentialing is later granted.

The practical lesson is that "completed application" carries the weight. The 60-day clock does not start on an application the plan considers incomplete, which is why a current, attested CAQH profile matters more in New York than any follow-up call.

Professionals who never bill New York Medicaid still have to enroll if they order or refer. eMedNY's OPRA FAQs (revised February 28, 2020) say physicians and other professionals ordering or referring services under the state plan or a waiver must enroll, and that it is the billing provider's job to confirm the ordering provider was enrolled on the date of service before submitting the claim. That check is the enrolled practitioner search on eMedNY or a call to (800) 343-9000.

This is where labs, imaging centers, physical therapy practices and DME suppliers lose claims they otherwise earned: the service was right, the referring doctor simply was not enrolled. The portal's OPRA applicant type exists for exactly that doctor.

New York's Medicare Administrative Contractor is National Government Services, the A/B MAC for Jurisdiction K. NGS began operating under the name Wellpoint Federal on April 1, 2026; the notice of the change says providers do not need to re-enroll and PECOS enrollment, revalidation cycles and reassignments are unchanged. You still file the CMS-855I or CMS-855B in PECOS. Our Medicare provider enrollment page explains which form fits which provider.

CMS's Medicare fee-for-service enrollment contact list (file dated March 24, 2026) lists New York's enrollment lines: Part B provider enrollment 888-379-3807 and Part A provider enrollment 855-593-8047. NGS publishes no New York-specific processing figure that we found; the standard every MAC is measured against is CMS's table in Program Integrity Manual chapter 10:

On retroactive billing, 42 CFR 424.521 lets physicians and non-physician practitioners bill Medicare for services up to 30 days before the effective date when circumstances prevented earlier enrollment (90 days after a Presidentially declared disaster), and no further back.

Railroad Retirement Board beneficiaries' Part B claims go to Palmetto GBA nationally, not to NGS, so a New York practice that sees them needs a Railroad Medicare PTAN in addition to its NGS PTAN. Palmetto's Railroad Medicare enrollment page has you request it with its PTAN Lookup and Request Tool once Part B is approved; it does not take a second CMS-855, sets the Railroad PTAN effective on your Part B effective date, and asks you to allow up to 30 days. Electronic claim enrollment with Palmetto is a separate step. The full walkthrough is in our Kentucky guide, where the steps are identical.

The New York files we see stall for reasons the portal makes predictable, and almost all of them start with the provider's own data:

• The 45-day draft expires while the practitioner is too busy to e-sign. The portal deletes it and the work starts over.
• An information request lands in a dead inbox. If the email on the file belongs to a departed office manager, the 45-day reply window passes unseen. Put the provider's own address as primary and a shared credentialing inbox as secondary.
• NPPES, license and CAQH disagree. An old practice address in NPPES or a CAQH profile that still lists last year's location makes the same provider look like two people to the reviewer and to every plan.
• Wrong applicant type. A referring-only doctor enrolled as a billing provider, or the reverse, means another application.
• No ETIN. The MMIS number arrives and claims still fail because the ETIN certification was never filed or confirmed.
• A missed revalidation letter. With 123 days from the first notice and a termination date attached, a letter that went to an old address is a real risk in the 2026 to 2028 cycle.
• Assuming state enrollment means network status. It does not; each managed care plan is its own application.
• An expired CAQH attestation, which CAQH asks you to renew every 120 days, stops every commercial and managed care plan reading the profile at once.

Our process is built around those failure points: one verified file compared field by field across the portal, NPPES, the license, CAQH and PECOS before anything is submitted, then weekly follow-up with every payer, logging the representative, the date and the reference number.

For New York you will need the individual and group NPIs with current NPPES addresses, the practitioner's own NY.GOV ID business account, the IRS letter showing the legal name and tax ID, the New York license number and dates, DEA and board certification where they apply, the malpractice certificate, bank details for the EFT form, ownership and managing-employee information for a group, every practice location, a current CAQH profile, and the Medicare approval letter once it arrives. Our checklist of what we need from you to start credentialing covers it, with a secure way to send it.

For the definitions behind all of this, see what provider credentialing is and CAQH explained. Other state guides: Florida and Kentucky.

ClaimCarePro enrolls providers with New York Medicaid in the Provider Services Portal, handles the Medicaid managed care plans and commercial insurers that follow, files Medicare with NGS through PECOS, requests the Railroad Medicare PTAN, and manages New York's revalidation notices, all as one checked file with weekly, logged payer follow-up. Flat pricing: $250 per payer application per provider, CAQH setup $250, re-credentialing $250, maintenance $99 per provider per year, or the new-practice bundle at $1,750 per provider ($1,400 each additional provider on the same group and payers). Start credentialing now and get a secure start link within one business hour, or call (844) 772-8902. Details are on our provider credentialing services page, and ongoing upkeep is on recredentialing.

Updated October 23, 2026. We read each New York source below on October 23, 2026, except where a different date is shown. If the Department of Health, eMedNY, a plan or CMS revises a rule, its own page governs over this guide, and none of this is legal advice.

• eMedNY, Provider Enrollment Guide: emedny.org (NPI first; PSP for new enrollment and reinstatement; determination with MMIS/PID and effective date; ETIN forms 490602 and 490501; ePACES; EFT form 701101; weekly remittances)
• NYS Department of Health, Medicaid Update, April 2026 (Vol. 42, No. 5), "Continued Development of the New York State Medicaid Provider Services Portal": health.ny.gov
• eMedNY, Provider Services Portal home: emedny.org; PSP New Practitioner Enrollment Overview training deck (February 10, 2026): emedny.org
• eMedNY, What's New in the PSP (last updated October 2, 2026): emedny.org
• NYS Department of Health, NYS Medicaid Provider Revalidation (revised September 2026): health.ny.gov
• eMedNY, Revalidation Information: emedny.org
• eMedNY, Application Fee: emedny.org ($750 for 2026)
• eMedNY, Medicaid Managed Care Network Providers: emedny.org; Medicaid Enrolled Provider Listing: health.data.ny.gov; Medicaid Pended Provider Listing: emedny.org file
• eMedNY, OPRA FAQs (revised February 28, 2020): emedny.org; enrolled practitioner search: emedny.org
• NYS Department of Health, Medicaid Update, May 2023 (Vol. 39, No. 10), "New York State Medicaid Program Ends Provisional Temporary Provider Enrollment": health.ny.gov
• NYS Department of Health, Medicaid managed care enrollment by county and plan, June 2026: health.ny.gov
• New York Public Health Law 4406-d (most recent revision April 17, 2020): nysenate.gov
• New York Insurance Law 4803 (most recent revision April 17, 2020): nysenate.gov
• CMS, Medicare Fee-for-Service Provider Enrollment Contact List (file dated March 24, 2026): cms.gov
• American Podiatric Medical Association, "NGS to Begin Operating Under New Name" (March 30, 2026): apma.org
• CMS, Medicare Program Integrity Manual, chapter 10 (read October 23, 2026 for our Medicare enrollment page): cms.gov
• 42 CFR 424.521, eCFR (read October 23, 2026 for our Medicare enrollment page): ecfr.gov
• Palmetto GBA, Enroll in Railroad Medicare (read October 23, 2026 for our Medicare enrollment page): palmettogba.com
• CAQH ProView Provider Quick Reference (read October 16, 2026 for our CAQH page): caqh.org (120-day re-attestation)

Not found, and therefore not stated: a current New York table assigning provider types to screening risk levels, a published credentialing timeline from any New York Medicaid managed care plan, an NGS processing figure specific to New York, and a statutory deadline for New York Medicaid enrollment itself.