Provider Enrollment & Maintenance

The Department of Health announces the launch of the New York State Medicaid program's coverage of the Centers for Disease Control and Prevention (CDC) National Diabetes Prevention Program (NDPP) for Medicaid Fee-For-Service (FFS), and Medicaid Managed Care (MMC) members. The NDPP is an evidence-based, educational and support program designed to assist at-risk individuals from developing Type 2 diabetes.

CDC Resources:

Provider Training Videos

eMedNY provides an "Introduction to Provider Enrollment" that walks providers through the steps of how to enroll as a provider of services for the NYS Medicaid program at: https://www.emedny.org/info/ProviderEnrollment/enrollguide.aspx

IMPORTANT: The NDPP Recognition Attestation (Form #434901) found at the link below is a requirement for all of the NDPP service provider types referenced below. NDPP providers seeking enrollment in NYS Medicaid must review and attest to all of the rules, obligations, and responsibilities contained therein to be able to enroll, and participate in the NYS Medicaid Program as an NDPP billing provider.

CDC-NDPP Recognition is the 1st Step

Clinics, groups, individuals, and organizations looking to enroll in Medicaid as an NDPP Service provider must first comply with the standards and guidelines set forth by the Centers for Disease Control and Prevention (CDC) as outlined in the a National Diabetes Prevention Recognition Program (DPRP), and obtain a valid, current CDC Pending, Preliminary, or Full NDPP recognition.

The NYS NDPP consists only of in-person, group training sessions. The "Delivery Mode" referenced on the CDC-NDPP recognition letter awarding Pending, Preliminary, or Full recognition must reference a "Delivery Mode" of "In-Person." If the CDC-recognition states a delivery mode of "Combination," additional documentation will have to be provided showing that an "In-Person" delivery modality is part of their "Combination" CDC-recognition. NDPP Delivery modes of "Online," and "Distance Learning" are not acceptable NYS Medicaid NDPP "Delivery Modes." NDPP provider enrollment applications will be withdrawn from consideration if they lack the required "In-Person" "Delivery Mode" requirement.

Clinics, groups, individuals, and organizations looking to enroll in Medicaid as an NDPP provider must first become recognized by the CDC prior to engaging in their Medicaid NDPP provider enrollment application process. However, providers that are required to obtain a new National Provider Identifier (NPI) may do so at any time through National Plan and Provider Enumeration Service (NPPES). You can obtain an NPI online at any time through the NPPES website: https://nppes.cms.hhs.gov/#/.
NDPP-Community Based Organizations (CBOs) & Practitioner Groups
1. Practitioner Group Practices that are currently enrolled in Medicaid under an already existing NPI
  You are required to obtain a new, unique National Provider Identifier (NPI) for the purposes of enrolling in Medicaid as an NDPP service provider. The newly acquired NDPP NPI will be enrolled in the Medicaid program under Category of Service 0572 and will be identified as a CBO solely for purposes of NDPP enrollment and claims payment. This identification does not affect or impact any other aspects of the Group’s Medicaid provider enrollment file.
2. If you are already recognized by the CDC, but not enrolled in Medicaid
  A Community Based Organization or Practitioner Group Practice that has achieved CDC-DPRP recognition to deliver NDPP services, and wants to enroll in Medicaid as an NDPP service provider, please continue to the link below for CBO enrollment instructions, requirements, and other important information about participating in the NYS Medicaid program as an NDPP service provider.
CBO Enrollment Forms & Instructions
Hospital Clinic (OPD) or Freestanding Clinic (D&TC)
1. If you are already recognized by the CDC, but not enrolled in Medicaid
  A Hospital Clinic (OPD) or Freestanding Clinic (D&TC) facility that has already achieved CDC-DPRP recognition to deliver NDPP services, please select the applicable Medicaid provider type link below for additional enrollment instructions, requirements, and other important information about participating in the NYS Medicaid program as an NDPP service provider.
2. If you are already Enrolled in Medicaid, but not recognized by the CDC
  A Hospital Clinic (OPD) or Freestanding Clinic (D&TC) facility that is already enrolled as a service provider in the NYS Medicaid program, and now wishes to deliver the CDC evidence-based, educational and support program designed to assist at-risk individuals from developing Type 2 diabetes, please see the CDC Diabetes Prevention Recognition Program Standards and Operating Procedures Handbook for additional information about first achieving CDC-DPRP recognition to become eligible to deliver NDPP services.
3. If you are already Enrolled in Medicaid, and already have CDC-DPRP Recognition
  As a Medicaid enrolled Hospital Clinic (OPD) or Freestanding Clinic (D&TC) facility that has achieved CDC-DPRP recognition to deliver NDPP services, please select the applicable Medicaid provider type below. Upon selecting your eligible enrollable provider type, you will navigate to the provider enrollment landing page for that specific provider type. Scroll down to the Maintenance Forms Section of the page and select the NDPP Recognition Attestation (Form #434901) and associated instructions. Please be sure to complete the NDPP Recognition Attestation and include any and all relevant documents received from the CDC stating that you have achieved National Diabetes Prevention Recognition Program (DPRP) recognition.
  Upon review and if approved you will be eligible to provide and be reimbursed for NDPP services. Upon approval you will be notified (via US Mail) by the Medicaid Program that the NDPP specialty code (105) has been added to your provider record.
Hospital (OPD) Enrollment Forms & Instructions

Freestanding Clinic (D&TC) Enrollment Forms & Instructions
Individual Practitioners (Physicians, Nurse Practitioners, Midwives)
1. If you are already recognized by the CDC, but not enrolled in Medicaid
  An Individual Practitioner that has already achieved CDC-DPRP recognition to deliver NDPP services, please select the applicable Medicaid provider type link below for additional enrollment instructions, requirements, and other important information about participating in the NYS Medicaid program as an NDPP service provider
2. If you are already Enrolled in Medicaid, but not recognized by the CDC
  An Individual Practitioner that is already enrolled as a service provider in the NYS Medicaid program, and now wishes to deliver the CDC evidence-based, educational and support program designed to assist at-risk individuals from developing Type 2 diabetes, please see the CDC Diabetes Prevention Recognition Program Standards and Operating Procedures Handbook for additional information about first achieving CDC-DPRP recognition to become eligible to deliver NDPP services.
3. If you are already Enrolled in Medicaid, and already have CDC-DPRP Recognition
  As a Medicaid enrolled Individual Practitioner that has achieved CDC-DPRP recognition to deliver NDPP services, please select the applicable Medicaid provider type below. Upon selecting your eligible enrollable provider type, you will navigate to the provider enrollment landing page for that specific provider type. Scroll down to the Maintenance Forms Section of the page and select the NDPP Recognition Attestation (Form #434901) and associated instructions. Please be sure to complete the NDPP Recognition Attestation and include any and all relevant documents received from the CDC stating that you have achieved National Diabetes Prevention Recognition Program (DPRP) recognition.
  Upon review and if approved you will be eligible to provide and be reimbursed for NDPP services. Upon approval you will be notified (via US Mail) by the Medicaid Program that the NDPP specialty code (105) has been added to your provider record.
Physician Enrollment Forms & Instructions

Nurse Practitioner Enrollment Forms & Instructions

Midwife Enrollment Forms & Instructions
Additional Resources
- eMedNY regional provider services representatives are available for in-person provider training and assistance throughout the State upon request. To request in-person training please contact the eMedNY Call Center at the phone number at 800-343-9000.
- Provider training videos on various topics including ePaces, information for new providers/new billers, provider enrollment, and the Medicaid Eligibility Verification System (MEVS) are available to assist at providers at: https://www.emedny.org/training/videos.aspx
- eMedNY provides an "Introduction to Provider Enrollment" that walks providers through the steps of how to enroll as a provider of services for the NYS Medicaid program at: https://www.emedny.org/info/ProviderEnrollment/enrollguide.aspx
- eMedNY provides a step-by-step process on how to submit and be paid for services rendered to eligible Medicaid clients at the same link referenced in the bullet directly above.
- For questions please e-mail ndpp@health.ny.gov.
- Please click here to sign up for the NYS Medicaid NDPP Listserv in order to receive a variety of important NDPP program updates and notifications pertaining to any program policy or billing requirements, scheduled webinars or trainings, and/or any other changes that may impact the provider community.