The simplest approach to become a Medicaid provider is to apply online. When you apply online, you have a lower chance of committing mistakes that will result in your application being denied and returned to you for rectification. If you do not enter all of the required information, you will be prompted to do so.
Fill out an Enrollment Form for Your Provider Type.
Prospective providers must file a NYS Medicaid Enrollment Application. Navigate to this website’s Provider Index page. Each Provider enrollment form includes the following information:
Applications that do not meet one or more of the requirements will be returned to the enrollee for completion.
The NYS Department of Health will assess completed applications. If additional information is required to process the application, the provider will be advised as to what information is required and where it should be sent.
The provider will be notified in writing of the approval or denial of the filed application.If the application is granted, the enrollee will get a letter including the provider’s MMIS ID Number, the effective date when services may be offered to an enrolled client, and other enrollment-related information.
The following is a checklist of provider qualifications and requirements.
Medicaid will accept specific petitions for retroactive effective dates if and only if the following conditions are met:
Medicaid cannot give preferential treatment to enrollment applications that are delayed owing to provider error, missing information, or a delay in getting credentialing, endorsement, or licensure information from another agency.
Re-credentialing is an assessment of a provider’s continuous eligibility for Medicaid participation. The terms re-credentialing, reverification, and revalidation are used interchangeably.
The Affordable Care Act requires providers to be recertified every five years. The provider’s credentials and qualifications are examined as part of the process to verify they satisfy programme standards and are in good standing. A criminal background check on all owners is also performed as part of the re-credentialing process, as is the management of relationships linked with the provider record.
The message center mailbox in the Tracks secure provider portal notifies providers of their upcoming re-credentialing due date.
Providers who do not complete the re-credentialing process on time will be barred from participating in the Medicaid programme. If the re-credentialing application is not submitted, reminders will be given 50 days, 20 days, and 5 days before the due date for provider re-credentialing. If a provider’s re-credentialing application is not filed before the re-credentialing due date, they will be suspended. Following a 50-day suspension, the provider will be removed from the Medicaid and Health Choice programmes.
It should be noted that re-credentialing does not apply to enrolled providers who have a term constraint, such as out-of-state providers. Every 365 days, out-of-state (OOS) providers must complete the enrollment process. For more information, please see the Tracks Provider Portal’s Provider Re-credentialing/Re-verification page.
Out-of-state providers may submit either a full application for a five-year enrollment period or a lite-enrollment application for a 12-month enrollment period.
If an OOS provider chooses to use the lite-enrollment application, the following rules will apply:
If an OOS provider chooses to use the full-enrollment application, the following rules will apply: