Welcome to the Provider Enrollment home page. Here you will find a complete array of documents necessary to successfully complete your enrollment process. There are now two approaches to locating your enrollment forms:

For maintenance forms go to the Provider Maintenance Forms page. (A good example of a Maintenance form is the new Default Electronic Transmitter Identification Number (ETIN) Selection form. This form will be essential in order to see Medicare Crossover Claims reported on your electronic remittance).

All Medicaid Provider Enrollment forms have been updated to include information on the Provider Compliance Program requirements found in Title 18NYCRR, Part 521.  To determine whether the Provider Compliance Program affects you, please visit the website of the Office of the Medicaid Inspector General at http://www.omig.ny.gov/data/content/view/81/206/

For specific enrollment needs, click on your provider type below and learn all about enrollment for your type.

We have also provided a Provider Enrollment Guide. If you have any questions or concerns, please contact the eMedNY Call Center at 1-800-343-9000 or email us at webmaster @ emedny.org.

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