NY Medicaid  
home | self help | glossary | site map

Information > Provider Enrollment Forms > Enrollment for Physician
Physician Enrollment

Effective 1/1/11, Physicians wishing to enroll in the FFS Medicaid program must also participate in the CAQH Universal Provider Datasource (UPD). Please follow the steps outlined below.

Physicians Enrolled in CAQH:

  • Complete the Physician Request for Enrollment Form to request enrollment in the New York State Fee-For-Service Medicaid Program.
  • If you are requesting reinstatement, you must submit the Prior Conduct Questionnaire.
  • If you meet the criteria, submit your OMIG Provider Compliance Confirmation. For more information go to the OMIG website at www.omig.ny.gov.
  • Office Based Surgery for those offices accredited to perform office based surgery under moderate, deep, or general anesthesia (EMEDNY 9325).
  • Enrollment as a group requires that all group members be enrolled as individual providers in the New York State Medicaid program.
  • A solo practitioner (PC) who chooses to bill the New York State Medicaid program using an EIN and organizational NPI must complete a group application and enroll as a one man group.
  • For questions regarding these documents contact the eMedNY Call Center at 1-800-343-9000.
  • Submit completed forms to:
    Computer Sciences Corporation
    P.O. Box 4603
    Rensselaer, NY 12144-4603

back to top

Physicians Not Enrolled in CAQH:

  • Go to www.caqh.org and complete the CAQH Registration kit. A CAQH Provider ID is needed to complete the online application. Go to https://upd.caqh.org/oas.
  • Click Logging in for the first time?.
  • Enter CAQH Provider ID.
    • If you do not have a CAQH ID, please call the eMedNY Call Center at 1-800-343-9000.
  • Enter authentication data.
  • Create username and password (write down this login information and keep it in a safe place).
  • What you need to complete the CAQH UPD:
    • CAQH Provider ID number (included in registration kit sent from CAQH).
    • Previously completed credentialing application (for reference)
    • List of all previous practice locations.
    • Copies of:
      • Curriculum vitae (resume)
      • Medical license
      • DEA certificate (if applicable)
      • IRS Form W-9
      • Malpractice insurance face sheet
      • Summary of any pending settled malpractice cases
  • Verify your data entry and attest.
  • Submit supporting documents to (866) 293-0414.
  • Once completed, please follow the instructions above for "Physicians Enrolled in CAQH".
  • For help completing the CAQH application, contact the CAQH Help Desk:

back to top

Once Enrolled, Eligible Providers May Enroll in Fee Enhancement Programs:

Once you have received your official approval as an enrolled provider in the NYS Fee-For-Service Medicaid Program, you may apply to the following programs to receive enhanced fees.

 Preferred Physicians And Children (PPAC) Program (101 KB)
 Medicaid Obstetrical and Maternal Services (MOMS) Program (220 KB)
 HIV Enhanced Fee Program (209 KB)

back to top

Helpful Resources:

 Frequently Asked Questions (FAQ's) (68 KB)
 Whom to Call List (100 KB)

Sub Menu contents