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.

1. CDC Diabetes Prevention Recognition Program Standards and Operating Procedures Handbook
2. CDC NDPP Recognition Application
3. CDC NDPP Registry of All Recognized Organizations

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.

Providers should be sure to submit the completed, signed, and dated NDPP Recognition Attestation (Form #434901) along with copies of the Organization's Pending recognition e-mail, or the Preliminary/Full recognition correspondence letter that was received from the CDC when NDPP recognition was achieved. Any Organizations which received Full recognition should also include a copy of the NDPP Certificate of Recognition.

• 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/#/.

• Community Based Organizations (CBOs)

  If you are already recognized by the CDC, but not enrolled in Medicaid
  All CBOs are required to obtain and enroll a new NPI for the purposes of enrolling in Medicaid as an NDPP service provider. This policy applies even if the CBO is currently enrolled in Medicaid under an already existing NPI, Category of Service (COS), and/or specialty code. They are still required to obtain a new, unique NPI for the purposes of enrolling in Medicaid as an NDPP service provider.

  Once the CBO has obtained their new NDPP NPI, and has also achieved either Pending, Preliminary or Full recognition from the CDC, they may move forward with applying to enroll in NYS Medicaid as an NDPP service provider.

  Once the CBO has obtained their new NDPP NPI, and has also achieved either Pending, Preliminary or Full recognition from the CDC, they may move forward with applying to enroll in NYS Medicaid as an NDPP service provider.

  Newly enrolling CBOs should complete, and submit the following NYS Medicaid enrollment forms along with the documentation received from the CDC stating that they have achieved National Diabetes Prevention Recognition Program (DPRP) recognition:

  • NDPP Recognition Attestation (EMEDNY-434901); and
  • NYS Medicaid Business Enrollment Form (EMEDNY-436701).

  The newly acquired NDPP NPI will be enrolled in the Medicaid program under COS 0572 and will be identified as a CBO solely for purposes of NDPP provider enrollment and claims payment.

  CBOs must also complete the following "NYS Medicaid Business Disclosure Form" any time they recertify their Medicaid enrollment, or anytime a new Lifestyle Coach is added to their Organization.

  • The NYS Medicaid Business Disclosure Form (EMEDNY-380101).

  All of the above referenced documents are also available on the "CBO Enrollment Forms & Instructions" link referenced below. Providers should also be sure to thoroughly review the "Requirements & Additional Forms" section of the eMedNY NDPP CBO provider enrollment page to ensure that they have reviewed, completed, and submitted all of the required Medicaid enrollment or maintenance transaction forms. Failure to provide the requested information will result in the application being deemed incomplete and returned to the provider unprocessed.

  Clinics, group practices, and organizations that are required to obtain a new National Provider Identifier (NPI) in order to enroll in Medicaid as an NDPP service provider may do so at any time through National Plan and Provider Enumeration Service (NPPES). An NPI can be obtained online at any time through the NPPES website: https://nppes.cms.hhs.gov/#/.

  The 0572 COS was established to identify the newly created CBO provider type within the Medicaid program. COS 0572 cannot be added to an existing NYS Medicaid provider enrollment file. An organization's enrollment in Medicaid under COS 0572 is a separate and distinct Medicaid enrollment, and will not affect any aspect of an organizations other Medicaid enrollment file(s). CBO's enrolled in Medicaid under COS 0572 may only be assigned specialty codes to render specific services as designated by the Department of Health (DOH). At this time, NDPP services under specialty code 105 is the only specialty code/service that has been approved by DOH to be rendered under COS 0572.

  
  

  CBO Enrollment Forms & Instructions

  
  
• Individual Practitioners (Physicians, Nurse Practitioners, Midwives)

  Individual practitioners are required to obtain an NPI for the purpose of enrolling in Medicaid as an NDPP service provider. If the practitioner is already enrolled in NYS Medicaid under an existing NPI, COS, and/or specialty code, then that same NPI may be utilized for NDPP enrollment purposes. In that situation, the new NDPP specialty code (105) will just be assigned to the practitioner's existing provider enrollment file.

  Once the practitioner has their NPI, and has also achieved either Pending, Preliminary or Full recognition from the CDC, they may move forward with applying to enroll in NYS Medicaid as an NDPP service provider.

  The practitioner would go to the Individual Practitioners (Physicians, Nurse Practitioners, Midwives) section of the eMedNY NDPP provider enrollment page located at https://www.emedny.org/info/ProviderEnrollment/NDPP/index.aspx, and click on the link for the applicable Medicaid provider type for additional enrollment instructions, requirements, and other important information about participating in the NYS Medicaid program as an NDPP service provider.

  Newly enrolling Individual Practitioners should complete, and submit the following NYS Medicaid enrollment forms along with the documentation received from the CDC stating that they have achieved DPRP recognition:

  • NDPP Recognition Attestation (EMEDNY-434901); and
  • NYS Medicaid Practitioner enrollment form (EMEDNY-436801); or
  • NYS Medicaid Ordering, Referring, Attending, Prescribing (OPRA) enrollment form (EMEDNY-436901) if the practitioner is looking to only enroll, and participate in Medicaid as a Managed Care provider.

  Individual practitioners that are already enrolled in Medicaid under an existing NPI, COS, and/or specialty code, and are looking to add the NDPP specialty code (105) should complete, and submit the following NYS Medicaid maintenance forms along with the documentation received from the CDC stating that they have achieved DPRP recognition:

  • NDPP Recognition Attestation (EMEDNY-434901); and
  • NYS Medicaid Practitioners or Physicians Disclosure Form (EMEDNY-380104).

  Individual practitioners must complete and submit the above "NYS Medicaid Practitioners or Physicians Disclosure Form" any time they recertify their Medicaid enrollment, or anytime a new Lifestyle Coach is added to their Organization.

  All of the above referenced documents are also available on the applicable Medicaid provider type link located on the eMedNY NDPP provider enrollment page referenced below. Practitioners should be also sure to thoroughly review the "Requirements & Additional Forms" section of the eMedNY NDPP provider enrollment page to ensure that they have reviewed, completed, and submitted all required Medicaid enrollment or maintenance transaction forms. Failure to provide the requested information will result in the application being deemed incomplete and returned to the provider unprocessed.

  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 in addition to any other professional specialty codes and/or professional COS codes (i.e., 0460 for physician, 0469 Nurse Practitioner, or 0525 Midwife, etc.) that may be applicable to the practitioner at the time of enrollment. If the practitioner is already enrolled in NYS Medicaid under an existing NPI, COS, and/or specialty code, the NDPP specialty code (105) will just be assigned to the practitioner's existing provider enrollment file.

  
  

  Physician Enrollment Forms & Instructions

  Nurse Practitioner Enrollment Forms & Instructions

  Midwife Enrollment Forms & Instructions

  
  
• Practitioner Groups

  Practitioner group practices are required to obtain and enroll a new NPI for the purposes of enrolling in Medicaid as an NDPP service provider. This policy applies even if the group practice is currently enrolled in Medicaid under an already existing NPI, Category of Service (COS), and/or specialty code. They are still required to obtain a new, unique NPI for the purposes of enrolling in Medicaid as an NDPP service provider.

  Once the group practice has acquired their new NDPP NPI, they will follow the same process referenced above under the "Community Based Organizations (CBOs)" section for the purpose of enrolling in Medicaid as an NDPP service provider.

  The newly acquired NDPP NPI will be enrolled in the Medicaid program under the COS 0572 and will be identified as a CBO solely for purposes of NDPP provider enrollment and claims payment. This identification does not affect or impact any other aspects of their Medicaid provider enrollment file. Once enrolled in Medicaid as an NDPP service provider, claims may be submitted to Medicaid for NDPP services rendered to Medicaid members.

• Hospital Clinic (OPD) or Freestanding Clinic (D&TC)

  Hospital clinics (OPDs), freestanding clinics (D&TCs), and Federally Qualified Health Centers (FQHCs) are required to obtain and enroll a new NPI for the purposes of enrolling in Medicaid as an NDPP service provider. This policy applies even if the OPD, D&TC, or FQHC is currently enrolled in Medicaid under an already existing NPI, COS, and/or specialty code. They are still required to obtain a new, unique NPI for the purposes of enrolling in Medicaid as an NDPP service provider.

  Once the OPD, D&TC, or FQHC has acquired their new NDPP NPI, they will follow the same process referenced above under the "Community Based Organizations (CBOs)" section for the purpose of enrolling in Medicaid as an NDPP service provider.

  The newly acquired NDPP NPI will be enrolled in the Medicaid program under the COS 0572 and will be identified as a CBO solely for purposes of NDPP provider enrollment and claims payment. This identification does not affect or impact any other aspects of their Medicaid provider enrollment file. Once enrolled in Medicaid as an NDPP service provider, claims may be submitted to Medicaid for NDPP services rendered to Medicaid members.

• 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.
  • Additional information pertaining to the Medicaid’s coverage of the CDC's evidence-based, educational and support NDPP program can be found on the State's Medicaid Redesign page located at https://health.ny.gov/health_care/medicaid/redesign/ndpp/index.htm