Credentialing Services in New York

Every clinician in a New York Medicaid managed care network has to be enrolled with NYS Medicaid, even if they never see a fee-for-service patient, and New York gives applicants just 45 days at each step before an application is deleted or withdrawn. Maximum Billing provides credentialing services for New York practices, handling NYS Medicaid enrollment, managed care plan credentialing, commercial plans, Medicare, and CAQH through revalidation.

Schedule a consultation or call 800-820-0364.

Client results as of 2026. Request a billing review.

New York Credentialing Services

• Picking billing or non-billing enrollment for each clinician and setting.
• Provider Services Portal applications with every certification statement and attachment.
• Group ownership and control disclosures, including percentages.
• Managed care plan credentialing and contracts after state approval.
• Commercial plans and Medicare enrollment, including PECOS.
• CAQH ProView profiles kept current.
• Revalidation handled when DOH sends each notice.

Enrolling Through eMedNY

The NYS Department of Health, through its Office of Health Insurance Programs, runs New York Medicaid. Claims and enrollment use eMedNY, and new enrollments are now filed in the NYS Medicaid Provider Services Portal with a NY.gov login. Most provider types choose between two routes:

• Billing provider, which allows fee-for-service billing as well as plan credentialing.
• Non-billing provider, for clinicians who only order, prescribe, or refer, or who only take part in managed care networks.

The clock matters: an application started but not submitted within 45 days is deleted, and one whose follow-up request sits unanswered for 45 days is withdrawn. Our New York Medicaid provider enrollment guide lists the forms for each provider type.

Managed Care Plans in New York

The 21st Century Cures Act requires NYS Medicaid enrollment for every managed care network clinician, and the non-billing Managed Care Network option exists for clinicians who never bill fee-for-service. Each plan is credentialed and contracted separately. The DOH plan directory, as of September 2026, includes Amida Care, CDPHP, Anthem, Excellus, Healthfirst, Highmark, Independent Health, MetroPlus, Molina Healthcare of New York, MVP, UnitedHealthcare of New York, and VNS Choice.

Behavioral Health Credentialing in New York

Under the July 2025 eMedNY policy manual for licensed mental health practitioners, LCSWs, LMHCs, and LMFTs need fee-for-service Medicaid enrollment to be paid for either fee-for-service or managed care members. Clinicians working in Article 28 clinics, or settings licensed under Articles 16, 29-I, 31, or 32, use the non-billing option. LMSWs cannot enroll on their own and work under an LCSW, psychologist, or psychiatrist, and clinicians on a limited permit cannot enroll. See our mental and behavioral health credentialing services and New York mental health billing services.

Prescribers, Dentists, and Fees

New York has denied fee-for-service prescriptions from unenrolled prescribers since 2013, so a clinician who only writes prescriptions still needs at least a non-billing enrollment. Dentists use the same Provider Services Portal. Individual physicians, dentists, and other individual practitioners pay no application fee. See our medical credentialing services and dental credentialing services.

Revalidation and Timelines

New York revalidates at least every five years and can call for it sooner; providers should wait for their individual notice before starting, and a provider who does not revalidate is terminated, losing the ability to order or refer as well. New York publishes no standard processing time, and plan credentialing starts only after state approval, so plan for several months before seeing managed care members.

Frequently Asked Questions

Do I need NYS Medicaid enrollment if I only see managed care members?

Yes. Every managed care network clinician must be enrolled; the non-billing Managed Care Network option covers clinicians who never bill fee-for-service.

Can an LMSW enroll in New York Medicaid?

Not independently. LMSWs must be supervised by an LCSW, psychologist, or psychiatrist.

How long do I have to finish a New York Medicaid application?

Forty-five days to submit after starting, and 45 days to answer any follow-up request.

Is there an application fee for New York clinicians?

Not for individual practitioners. Institutional providers pay the federal fee.

Credentialing for New York Practices

Tell us about your clinicians, settings, and the plans you want to join, and we will choose the right enrollment route for each. We also handle New York medical billing once contracts are active. See our credentialing and payer enrollment services, or contact us to get started.