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Provider Enrollment
Provider Enrollment > Dialysis Centers (Out-of-State)

To enroll a Dialysis Center (Out-of-State) in New York State Medicaid, you must send a Remittance Advice (UB-04) showing hemodialysis services were provided and that the eligibility was verified for the Client. Send Remittance Advice (UB-04) to the New York State Department of Health Institutional Enrollment Unit of the Bureau of Provider Enrollment, 150 Broadway, Suite 6E, Albany, NY 12204. You must also have a CMS or Home-State Operating Certificate. Once reviewed and approved, an enrollment package will be mailed to the address provided.

Please Note: Existing providers have the option of billing new programs or services with an NPI already enrolled with the NY State Medicaid Program or an NPI unknown to NYS Medicaid. To report an unknown NPI, an enrollment application will be sent to you to complete and return to Medicaid's fiscal agent, Computer Sciences Corporation (CSC). Adding a new service or program to an enrolled NPI may require completion of other enrollment documents. Please contact the Institutional Enrollment Unit of the Bureau of Provider Enrollment at (518) 474-3575, option 8 or (800) 342-3005, option 8 if you have any questions regarding these NPI options.

Enrollment Checklist

To expedite the enrollment process, begin collecting the following documents/information:

The names, titles, home addresses and SSN's and dates of birth for owners, members of Board of Directors, Compliance Officer, stockholders, managing employees, etc. If ownership is corporate, FEIN and corporate addresses needed. Subcontractor information may be required. For Definitions of ownership, indirect ownership, managing employee, refer to NYCRR Title 18 Section 504.1.


A copy of the facility’s Home-State/CMS license to cover the application date through the current date.


A copy of your FEIN documentation showing both the name and number preprinted (a W-9 is not sufficient for enrollment purposes).


A copy of your Medicare award or participation letter.


A copy of your NPI assignment notification.


List from State/CMS showing number of approved Hemodialysis stations.


A confirmation notice for the OMIG Provider Compliance Program may be required. Visit www.omig.ny.gov to determine if the provider must comply. If yes, copy of the confirmation notice (printed from the website) must be included with the enrollment application.


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