NY Medicaid  
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Request for Financial Reports

This form may be used by enrolled providers to request information on their NY Medicaid financial file. Please check below the report you are requesting.

Please be advised that requests for reports will be processed no more than every six(6) months for the same provider.


Requested Report:


Provider Name:
Requestor Name: (your name)
Requestor Email:
MMIS ID


ReCaptcha:







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