Provider Enrollment > Medicaid Managed Care Network Provider Enrollment

Medicaid Managed Care Network Provider Enrollment

FAQs

The 21st Century Cures Act requires all Medicaid Managed Care and Children's Health Insurance Program network providers to be enrolled with State Medicaid programs no later than January 1, 2018.

If you received a letter from your Managed Care Organization stating that you have been identified as a provider who is not actively enrolled with the NYS Medicaid program and are providing services to their Medicaid eligible members, you must enroll or you will be removed from their Medicaid Managed Care provider network.

The Medicaid provider enrollment process is to ensure appropriate and consistent screening of providers and improve program integrity. In order to enroll, you will need to go to Provider Index and navigate to your provider type to print and review the instructions and enrollment form. Here, you will also find a Provider Enrollment Guide and How Do I Do It? resource guide. The Useful Links below includes, FAQs, and additional information related to the Medicaid Managed Care(MMC) network provider enrollment in New York State Medicaid.

Important: Your application must be received by CSRA, the Medicaid fiscal agent, by December 1, 2017. If you have questions during the NYS Medicaid Enrollment process, please contact CSRA's eMedNY Call Center at (800) 343-9000.

Useful Links


ATTENTION!!! We are changing the frequency of the data sets posted to eMedNY.org and Health Data NY (HDNY). The data will now be updated on a weekly basis. Section 5006 of the 21st Century Cures Act requires state Medicaid agencies to publish a Medicaid fee for service (FFS) provider directory. We changed the name of the Active provider file on HDNY to the "Medicaid Enrolled Provider Listing" as it now distinguishes providers enrolled as FFS, Managed Care (cannot bill FFS) and OPRA (cannot bill FFS).

Three previous data elements have been renamed (ex: MMIS ID has been changed to Medicaid Provider ID), please refer to the Data Dictionary-Change Log, Version 1.3 for further details. The change log will be available upon navigating to HDNY.

We added several new data elements as follows:
  • Medicaid type
  • provider specialty
  • service address
  • city
  • zip code
  • telephone number
  • latitude
  • longitude
  • enrollment begin date
  • next anticipated revalidation date

We encourage Managed Care Organizations (MCOs) to review and become familiar with the updated layout and additional data elements.

The Medicaid Enrolled Provider Listing data set is now public on Health Data NY (see link below). This data set provides a listing of providers enrolled in Medicaid. Managed Care Organizations (MCOs) can download this data set and use it to determine which providers are enrolled in Medicaid.

  • MCO's and Providers can now view the *next anticipated revalidation date for any provider enrolled in NYS Medicaid.
    *Disclaimer: The Next Anticipated Revalidation date is subject to change based upon additional provider submitted application events that may occur. These are likely due to (but not limited to) a change of ownership, recently received or processed revalidation, reinstatement, etc.

Link to the Active data set: https://health.data.ny.gov/Health/Medicaid-Enrolled-Provider-Listing/keti-qx5t

The Medicaid FFS Pending Provider Listing has also been renamed to "Medicaid Pended Provider Listing". The Medicaid Pended Provider Listing reflects providers who have submitted an application to NYS, but a decision has not been made and they are not enrolled. Managed Care Organizations (MCO's) can review this data set to determine which providers have submitted applications but are not yet enrolled in Medicaid.

MEDICAID PENDING PROVIDER LISTING Last Modified: 10/14/2019 MEDICAID PENDING PROVIDER LISTING - Text File

MEDICAID PENDING PROVIDER LISTING DATA DICTIONARY