Every clinician who treats New York Medicaid members needs to be enrolled with NYS Medicaid, including clinicians who only see managed care members and never bill fee-for-service. Enrollment runs through the eMedNY system and the NYS Medicaid Provider Services Portal, and the details differ by provider type. Here is how New York Medicaid provider enrollment works, step by step, as of 2026.
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Who Runs Medicaid Enrollment in New York
New York Medicaid is administered by the NYS Department of Health (DOH) through its Office of Health Insurance Programs. Claims and enrollment run through eMedNY, and DOH staff review enrollment applications. New enrollments, reinstatements, and enrollment maintenance for all provider types are now submitted through the NYS Medicaid Provider Services Portal, which you sign in to with a NY.gov account.
Before You Start
- An individual NPI from NPPES, and a group NPI if you bill as a group.
- A current New York license or registration with a future expiration date.
- A DEA certificate if you prescribe controlled substances, and board certification if you enroll as a specialist.
- Banking information for electronic funds transfer.
- A NY.gov login for the Provider Services Portal.
How to Enroll, Step by Step
- Get your NPI. New York requires it before you apply.
- Choose your provider type and enrollment option. Most provider types can enroll either as a billing provider or as a non-billing provider. The non-billing option covers clinicians who only order, prescribe, or refer (OPRA) and clinicians who only participate in managed care networks.
- Submit the application in the Provider Services Portal with the required attachments.
- Respond to any requests from DOH. An application that is started but not submitted within 45 days is deleted, and an application whose follow-up request goes unanswered for 45 days is withdrawn.
- Receive a written determination. Once approved, you can bill fee-for-service Medicaid (if enrolled as a billing provider) and complete credentialing with managed care plans.
Documents and Disclosures
For a physician enrolling as a billing provider, eMedNY lists proof of license, a DEA certificate if applicable, board certifications for specialists, the provider certification statement (EMEDNY-490602 for new enrollments, 490601 for reinstatements), the ETIN certification statement, the EFT authorization form (701101), and a prior conduct questionnaire if applicable. Group enrollments require full ownership and control disclosure under federal rules, including ownership percentages, and the group form notes that unannounced site visits may be a condition of enrollment and that owners with 5% or more interest may be required to consent to criminal background checks, including fingerprinting.
Is There an Application Fee?
Individual physicians and other individual practitioners do not pay an application fee; eMedNY’s physician and dentist enrollment pages state that no fee is required. Institutional providers pay the federal application fee, which is $750 for calendar year 2026, per Provider ID. The fee is waived if you are already enrolled in Medicare or another state’s Medicaid or CHIP program and have paid it there.
Managed Care Plans Require Enrollment Too
Under the 21st Century Cures Act, every clinician in a New York Medicaid managed care network must be enrolled with NYS Medicaid. You do not have to see fee-for-service patients to meet this requirement; the non-billing Managed Care Network option exists for exactly this purpose. After enrollment, you still need to credential and contract with each plan separately. As of September 2026, the DOH plan directory lists plans including 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 Clinicians
According to the eMedNY policy manual for licensed mental health practitioners (July 2025), LCSWs, LMHCs, and LMFTs must be enrolled in fee-for-service Medicaid to be paid for either fee-for-service or managed care members. Clinicians who work in Article 28 clinics, or in settings licensed under Articles 16, 29-I, 31, or 32, enroll under the non-billing option instead. LMSWs cannot enroll on their own and must be supervised by an LCSW, psychologist, or psychiatrist, and clinicians practicing under a limited permit cannot enroll. Our New York behavioral health billing page covers the billing side in more detail.
Ordering, Prescribing, and Referring Providers
Any clinician who orders, prescribes, or refers for New York Medicaid members must be enrolled, even if they never submit a claim. Fee-for-service prescriptions written by unenrolled prescribers have been denied since 2013, so even a clinician who only writes prescriptions needs at least a non-billing enrollment.
Dentists
Dentists enroll through the same Provider Services Portal, and eMedNY’s dentist enrollment page states that no application fee is required.
Revalidation
New York requires revalidation at least every five years, and DOH can require it sooner. Wait for your individual revalidation notice before starting. A provider who fails to revalidate is terminated, which also ends the ability to order or refer.
How Long It Takes
New York does not publish a standard processing time for enrollment. Plan for several months between submitting the application and being ready to see Medicaid managed care members, because plan credentialing begins only after Medicaid enrollment is approved.
Common Reasons Applications Stall
- Choosing the wrong enrollment option (billing versus non-billing) for the setting.
- A license that expires before the application is processed.
- Missing certification statements or an incomplete ownership disclosure for a group.
- Missing the 45-day windows to submit or to answer a request.
Let Us Handle New York Medicaid Enrollment
Maximum Billing handles Medicaid enrollment, managed care credentialing, CAQH, and revalidation tracking for practices in New York and eleven other states. See our behavioral health credentialing services, medical credentialing services, and dental credentialing services, or contact us to get started.
This guide reflects official NYS Department of Health and eMedNY information as of October 2026. Requirements change, so confirm current rules on eMedNY before you apply.