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New York Medicaid Provider Enrollment Through eMedNY, Explained

New York Medicaid is run by the NYS Department of Health (DOH) through its Office of Health Insurance Programs, and eMedNY is the state's Medicaid claims and enrollment system. Getting paid for New York Medicaid members takes two separate things: an enrollment with NY Medicaid, now filed online in the eMedNY Provider Services Portal, and a credentialed contract with each managed care plan whose members you want to see. This guide explains both, the screening rules that decide how long the state step takes, and the statewide revalidation effort that started in 2026.

Two Layers: State Enrollment and Plan Credentialing

The state layer is enrollment. The DOH Bureau of Provider Enrollment reviews applications submitted through eMedNY and issues an eight-digit NY Medicaid provider ID. Enrollment establishes that you are licensed, not excluded and eligible to be paid by NY Medicaid.

The plan layer is credentialing and contracting. Most NY Medicaid members are enrolled in a managed care plan, and each plan verifies your credentials, decides whether to accept you, and issues its own contract and rates. The state ID does not put you in any plan's network.

The two layers are linked in one direction. The 21st Century Cures Act required Medicaid managed care network providers to be enrolled with the state Medicaid program by January 1, 2018, and eMedNY states that a provider who gets a letter from a plan saying it is not actively enrolled must enroll or be removed from that plan's network. Enroll with eMedNY first, and start the plan applications as soon as the ID is issued.

The eMedNY Enrollment Application

New York moved enrollment online. Newly enrolling providers who have never been enrolled must apply in the Provider Services Portal (PSP), not on paper, and paper revalidations are no longer accepted. Each person using the portal needs a NY.GOV ID business account with multifactor authentication, including practitioners, credentialers and office staff. For a physician the portal asks for:

• Proof of a current license or registration, and DEA registration if you prescribe, administer or dispense controlled substances
• Specialty documentation, such as board certification, for any specialty you list
• An EFT authorization for new enrollees, and the ETIN Certification Statement, form EMEDNY-490602, for providers never enrolled before
• Group affiliation, by entering the enrolled group's provider ID
• The Prior Conduct Questionnaire, if you answer yes to any disclosure question
• CLIA documentation for a physician office lab, if applicable

Two deadlines matter. An application not submitted within 45 days of starting is deleted and must be restarted, and if the state asks for more information you have 45 days to respond or the application is withdrawn. Every service address needs a valid phone number. The practitioner, owner or an authorized representative signs and submits electronically. The eMedNY Call Center is at 1-800-343-9000. Paper forms such as EMEDNY-436801 for practitioners remain for reinstatement, mailed to eMedNY, PO Box 4603, Rensselaer, NY 12144-4603.

Application Fees

Whether a fee applies depends on the category of service, and the portal prompts you when one is required. Physicians enrolling under category of service 0460 pay no fee. Where a fee applies it is $750 for 2026, the federal amount set by CMS, payable to the NYS Department of Health with your NPI or FEIN. Each provider ID is a separate enrollment, so a fee applies to each one with a fee-bearing category of service, and the fee is not refunded if enrollment is denied. The fee is waived for providers enrolled in Medicare or another state's Medicaid program or CHIP, or that already paid it to Medicare. A hardship waiver request goes in with the application, and NY Medicaid forwards it to CMS for review.

Risk Levels: Who Gets a Site Visit, Who Gets Fingerprinted

Federal Medicaid rules at 42 CFR Part 455 require each state to screen providers according to a risk level assigned by provider type. New York keeps the CMS-established risk levels, with three state additions treated as high risk: ABA providers, 1915(c) waiver service providers and licensed home care services agencies.

A provider's risk level can rise after a payment suspension based on a credible allegation of fraud, an unreported Medicaid overpayment of $1,500 or more, an exclusion followed by reinstatement, or the lifting of a moratorium on its provider type. In 2026 New York also put enrollment moratoriums of at least six months on laboratories, DMEPOS suppliers, ABA providers, licensed home care services agencies, pharmacies and some managed long term care plans, and no pending applications in those categories are processed during a moratorium.

Revalidation

Federal rules require revalidation at least every five years, and the Department may request it at any time. Following an April 2026 CMS directive to revalidate every enrolled provider within 24 months, New York began phased notices in July 2026 and expects all revalidations complete by the second quarter of 2028. It now sets cycles by risk level:

• Limited risk: every five years, and revalidation can be met by registering in the portal and reviewing and recertifying your file
• Moderate risk: every four years, with site visits
• High risk: every three years, with site visits and fingerprinting

Notices are mailed and emailed and include a PIN, which links your existing enrollment to your portal account. You can keep billing while a submitted revalidation is in process unless DOH contacts you. Failing to revalidate ends the enrollment, after which you can no longer be paid or order, refer or prescribe for NY Medicaid members, and a terminated enrollment must be reinstated rather than revalidated, with a possible gap if you file more than 90 days after termination.

The New York Medicaid Managed Care Plans

The DOH managed care plan directory, revised September 2026, lists these mainstream Medicaid plans and their counties. Plans also offer Health and Recovery Plans (HARPs), for adults with serious behavioral health needs, in their counties:

• Fidelis Care: all 62 counties
• UnitedHealthcare Community Plan: 46 counties, including New York City, Long Island, the Hudson Valley, the Capital Region, Rochester, Syracuse and Buffalo
• MVP Health Plan: 30 counties across the Capital Region, Hudson Valley, North Country and Rochester area
• Molina Healthcare of New York: 28 counties, including New York City, Long Island, Westchester, Rochester, Syracuse and Western New York
• Excellus Health Plan: 13 counties across Central and Western New York, including Monroe, Onondaga, Oneida, Broome and Erie
• Capital District Physicians' Health Plan (CDPHP): 11 Capital Region counties, including Albany, Saratoga, Schenectady and Rensselaer
• Highmark Western and Northeastern New York: Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans and Wyoming
• Independent Health: Erie
• Healthfirst: the five New York City boroughs, Nassau, Suffolk, Westchester, Orange, Rockland and Sullivan
• Anthem HP: the five boroughs, Nassau, Suffolk, Westchester, Dutchess, Orange, Putnam, Rockland and Ulster
• Health Insurance Plan of Greater New York: the five boroughs, Nassau, Suffolk and Westchester
• MetroPlus Health Plan: the five New York City boroughs

Each plan takes a request through its own provider application, verifies credentials, often from your CAQH (now DataSpring) profile, and issues its own contract. In New York City and the surrounding counties a practice may want five or more plans, so map which plans your patients actually carry before you apply.

Typical Timeline, Start to Finish

• Document gathering, NY.GOV ID setup and CAQH build or update: typically 1 to 2 weeks
• eMedNY enrollment in the portal: under 20 days as of August 2026, per DOH
• Moderate or high risk types: longer, because site visits and fingerprinting are added
• Plan credentialing after the state ID: typically 45 to 120 days per plan, run in parallel

A practice that files in the portal on day one and sends every plan request the day the ID arrives is typically billing its plans within three to five months. Have the CAQH profile attested and authorized for each plan before the ID arrives so nothing is waiting on you.

Where NY Medicaid Applications Go Wrong

• An application started but not submitted within 45 days, which the portal deletes
• A request for more information not answered within 45 days, which withdraws the application
• Missing Social Security numbers, home addresses or dates of birth in the ownership and control disclosure
• A revalidation notice and PIN sent to an old address or an unwatched email inbox
• A service address entered without a valid phone number
• Plan requests submitted before the state ID exists
• CAQH profile not authorized for a specific plan, which stalls that plan and only that plan

How PECS Handles NY Medicaid

PECS prepares and submits the eMedNY application in the Provider Services Portal, tracks it with DOH, then files the managed care plan applications for your counties the day the ID is issued, with regular follow-up to every payer and each contact logged to your reference number at pecs.health/status. NY Medicaid enrollment is $500 per provider and each managed care plan application is $200 per application per provider, both billed 50% at engagement and 50% at submission. CAQH (now DataSpring) build is $500 and update is $250. Ongoing maintenance at $100 per provider per quarter includes revalidation tracking so your notice and PIN are handled when the 2026 to 2028 revalidation wave reaches you.

Frequently Asked Questions

By the PECS credentialing team, updated October 19, 2026.