Credentialing by state / New York
Nurse Practitioner Credentialing in New York
Enrollments are billed 50% at the start and 50% at submission; everything else 100% at the start.
| NP practice environment | Full Practice (AANP) |
|---|---|
| Licensing authority | The New York board of nursing alone |
| Medicare contractor | National Government Services, jurisdiction JK |
| Medicaid | New York Medicaid, enrolled through eMedNY |
| Medicaid managed care | 21 plans, 4,751,430 members (2024) |
| Blue Cross Blue Shield plan | Anthem Blue Cross Blue Shield (formerly Empire), Excellus BlueCross BlueShield and Highmark Blue Cross Blue Shield of Western New York |
New York Is a Full Practice State
The American Association of Nurse Practitioners classifies New York as full practice: state law lets nurse practitioners evaluate patients, diagnose, order and interpret tests, and prescribe under the exclusive licensure authority of the state board of nursing. 28 of the 50 states and DC have that classification.
For credentialing, full practice means the application is about you alone. New York Medicaid and the commercial plans in New York generally do not ask for a collaborating physician, so the fields that hold up NP files in other states are simply absent. Medicare's rule for NP services (42 CFR 410.75) defers to state law on collaboration, and where state law is silent it expects the NP to document their scope of practice and how they work with physicians on issues outside it. Enrollment itself runs through PECOS and National Government Services on the CMS-855I like any other independent practitioner.
What still slows New York NPs down is the business side: an NP-owned entity needs its own Type 2 NPI, a group enrollment and a reassignment for each clinician, and some commercial plans review NP-owned practices more slowly than physician groups. If you are new to independent practice, confirm with the board whether any transition-to-practice hours apply to you before the applications go in, because payers will ask for the license status that results.
New York Medicaid Managed-Care Plans for NPs
After the state enrollment, each managed-care plan credentials you as its own application. The largest in New York by 2024 enrollment:
- Fidelis Care: 1,532,160 members, owned by Centene
- Healthfirst Health Plan: 1,165,758 members
- MetroPlus Health Plan: 424,733 members
See all 21 plans.
Neighboring States
If you practice near the border or by telehealth, the rules change at the state line: New Jersey is reduced practice, Pennsylvania is reduced practice. Connecticut, Massachusetts, Vermont share New York's classification.
- Connecticut NP credentialing (Full Practice)
- Massachusetts NP credentialing (Full Practice)
- New Jersey NP credentialing (Reduced Practice)
- Pennsylvania NP credentialing (Reduced Practice)
- Vermont NP credentialing (Full Practice)
The full NP checklist, the entity decision and where applications stall are in our nurse practitioner credentialing guide. For Medicare, Medicaid and commercial plans for every clinician type in the state, see credentialing in New York.
Questions New York NPs Ask
Do New York nurse practitioners need a collaborating physician to get credentialed?
No. AANP classifies New York as full practice, so payers generally do not require a collaborating physician on an NP application. Check with the board of nursing whether any transition-to-practice requirement applies to a newly licensed NP.
How does a New York NP join New York Medicaid?
Enroll with the New York State Department of Health through eMedNY. Most New York Medicaid members are in managed care (4,751,430 enrolled across 21 plans in 2024), so after the state enrollment is active, each plan you want, such as Fidelis Care, Healthfirst Health Plan, MetroPlus Health Plan, credentials you separately.
Can an NP licensed in New York see patients in a neighboring state?
Only with a license from that state, and each state's practice rules apply to the patients there. Connecticut is full practice; Massachusetts is full practice; New Jersey is reduced practice; Pennsylvania is reduced practice; Vermont is full practice. Payer enrollment is also per state, so seeing patients across the line means a separate Medicaid enrollment and separate commercial applications there.
What does PECS charge a New York NP?
CAQH (DataSpring) profile build $500; Medicare enrollment $500; New York Medicaid enrollment $500; each commercial application, including Anthem Blue Cross Blue Shield (formerly Empire), Excellus BlueCross BlueShield and Highmark Blue Cross Blue Shield of Western New York, $200 per provider. Enrollment services bill 50% at engagement and 50% at submission.
Answers cover PECS services, prices and process. For legal, tax or clinical questions please consult a professional.
Sources: American Association of Nurse Practitioners, State Practice Environment (updated May 2026); KFF, Medicaid MCO Enrollment by Plan and Parent Firm, 2024. Practice classification is AANP's; confirm current rules with the New York board of nursing. Updated October 7, 2026.